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Thorac Cardiovasc Surg 2020; 68(08): 695-699
DOI: 10.1055/s-0039-1695758
Original Cardiovascular

Ligation of Left Atrial Appendage during Off-Pump Coronary Surgery

Soslan Enginoev 
1   Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
2   Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia
,
Dmitry Koz'min
1   Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
,
Gasan Magomedov
1   Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
,
Sergey Makeev
1   Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
,
Igor Chernov
1   Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
,
Nikolay Ilov
1   Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
2   Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia
,
Dmiry Tarasov
1   Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
2   Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia
,
Konstantin Zhigalov 
3   Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Alexander Weymann
3   Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Abstract

Objective The main purpose of this article is to evaluate an impact of epicardial ligation of the left atrial appendage (LAA) in patients with atrial fibrillation (AF) undergoing off-pump coronary artery bypass grafting (OPCAB) on the development of ischemic stroke and mortality.

Methods From 2009 to 2013, a total of 125 patients (86.4% men, mean age 64 ± 7 years, 95% confidence interval: 61–65 years) received a combined OPCAB and LAA ligation because of coronary artery disease and AF. All the subjects were divided into two groups: group 1 (n = 57)—LAA ligation during OPCAB, group 2 (n = 68) without LAA ligation during OPCAB. Primary endpoints were postoperative incidence of ischemic stroke and mortality.

Results No difference in the number of ischemic stroke (0 vs. 5.9%) and death (0 vs. 4.4%) in both groups during the hospital period (p > 0.05). Median overall follow-up was 41 (22–61) months: without difference for groups (p > 0.05). During follow-up, there was a difference in the number of ischemic stroke (0 vs. 17.6%, p < 0.001), while there was no difference in mortality in two study groups (5.3 vs. 16.2%, p > 0.05).

Conclusion Epicardial ligation of LAA during OPCAB in patients with AF may reduce the risk of ischemic stroke in long-term follow-up and does not affect the mortality.

Keyword

off-pump coronary surgery - left atrial appendage - atrial fibrillation

Authors' Contributions

S. Enginoev: conception and design, data analysis and interpretation, manuscript writing, final approval of manuscript, surgical team; D. Koz'min, G. Magomedov, S. Makeev: conception and design, surgical team; I. Chernov, D. Tarasov: final approval of manuscript, surgical team; N. Ilov: conception and design, data analysis and interpretation, manuscript writing; K. Zhigalov, A. Weymann: manuscript writing, supervision, final approval of manuscript.




Publication History

Received: 17 March 2019

Accepted: 16 July 2019

Article published online:
10 September 2019

© 2020. Thieme. All rights reserved.

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