Ligation of Left Atrial Appendage during Off-Pump Coronary Surgery

Soslan Enginoev; Dmitry Koz'min; Gasan Magomedov; Sergey Makeev; Igor Chernov; Nikolay Ilov; Dmiry Tarasov; Konstantin Zhigalov; Alexander Weymann

doi:10.1055/s-0039-1695758

The Thoracic and Cardiovascular Surgeon, Table of Contents

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

¹Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia

²Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia

,

Dmitry Koz'min

¹Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia

,

Gasan Magomedov

¹Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia

,

Sergey Makeev

¹Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia

,

Igor Chernov

¹Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia

,

Nikolay Ilov

¹Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia

²Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia

,

Dmiry Tarasov

¹Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia

²Department of Cardiac Surgery, Astrakhan State Medical University, Astrakhan, Russia

,

Konstantin Zhigalov

³Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany

,

Alexander Weymann

³Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany

› Author Affiliations

Abstract

All articles of this category

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

Full Text

References

References
1 Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med 1995; 155 (05) 469-473
2 Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med 1987; 147 (09) 1561-1564
3 Steger C, Pratter A, Martinek-Bregel M. et al. Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry. Eur Heart J 2004; 25 (19) 1734-1740
4 Jørgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke 1996; 27 (10) 1765-1769
5 Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 1996; 61 (02) 755-759
6 Stoddard MF, Dawkins PR, Prince CR, Ammash NM. Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study. J Am Coll Cardiol 1995; 25 (02) 452-459
7 Ohyama H, Hosomi N, Takahashi T. et al. Comparison of magnetic resonance imaging and transesophageal echocardiography in detection of thrombus in the left atrial appendage. Stroke 2003; 34 (10) 2436-2439
8 January CT, Wann LS, Alpert JS. et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130 (23) e199-e267
9 Kalra L, Yu G, Perez I, Lakhani A, Donaldson N. Prospective cohort study to determine if trial efficacy of anticoagulation for stroke prevention in atrial fibrillation translates into clinical effectiveness. BMJ 2000; 320 (7244): 1236-1239
10 Ruiz Ortiz M, Romo Peñas E, Franco Zapata MF. et al. Oral anticoagulation in patients aged 75 years or older with chronic non-valvar atrial fibrillation: effectiveness and safety in daily clinical practice. Heart 2005; 91 (09) 1225-1226
11 Whitlock R, Healey J, Vincent J. et al. Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III. Ann Cardiothorac Surg 2014; 3 (01) 45-54
12 Fuster V, Rydén LE, Cannom DS. et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol 2011; 57 (11) e101-e198
13 Kanderian AS, Gillinov AM, Pettersson GB, Blackstone E, Klein AL. Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol 2008; 52 (11) 924-929
14 Katz ES, Tsiamtsiouris T, Applebaum RM, Schwartzbard A, Tunick PA, Kronzon I. Surgical left atrial appendage ligation is frequently incomplete: a transesophageal echocardiographic study. J Am Coll Cardiol 2000; 36 (02) 468-471