Impact of Left Atrial Appendage Amputation on Left Atrial Morphology and Rhythm after Off-Pump CABG

Muhammed Gerçek; Mina Ghabrial; Lina Glaubitz; Oliver Kuss; Anas Aboud; Lech Paluszkiewicz; Jan Gummert; Jochen Börgermann; Mustafa Gerçek

doi:10.1055/s-0041-1735809

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2023; 71(04): 273-281
DOI: 10.1055/s-0041-1735809

Original Cardiovascular

Impact of Left Atrial Appendage Amputation on Left Atrial Morphology and Rhythm after Off-Pump CABG

Muhammed Gerçek

¹Herz-und Diabeteszentrum NRW, Clinic for General and Interventional Cardiology/Angiology, Bad Oeynhausen, Germany

,

Mina Ghabrial

²Herz- und Diabeteszentrum NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany

,

Lina Glaubitz

³Institute for Occupational, Social and Environmental Medicine, Center for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

,

Oliver Kuss

⁴Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Institut für Biometrie und Epidemiologie, Düsseldorf, Germany

,

Anas Aboud

⁵Department of Cardiac and Thoracic Vascular Surgery, Universitätsklinikum Schleswig-Holstein, University Heart Center Lübeck, Lübeck, Germany

,

Lech Paluszkiewicz

²Herz- und Diabeteszentrum NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany

,

Jan Gummert

²Herz- und Diabeteszentrum NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany

,

Jochen Börgermann

⁶Heart Center Duisburg, Clinic for Cardiovascular Surgery, Duisburg, Germany

,

Mustafa Gerçek

⁶Heart Center Duisburg, Clinic for Cardiovascular Surgery, Duisburg, Germany

› Author Affiliations

Abstract

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Abstract

Objectives Left atrial appendage (LAA) amputation concomitant to coronary artery bypass grafting (CABG) has become an increasingly performed technique in patients with atrial fibrillation (AF) or with sinus rhythm and a CHA2DS2-VASc score ≥2. However, LAA amputation has come under suspicion to cause postoperative atrial fibrillation (POAF) due to left atrial (LA) dilation. This study aims to assess this assumption in patients undergoing CABG in off-pump technique with and without amputation of the LAA.

Methods Patients who underwent isolated CABG in off-pump technique without history of AF were retrospectively examined. Cohorts were divided according to the concomitant execution of LAA amputation. LA volume was measured by transthoracic echocardiography and rhythm was analyzed by electrocardiography, medication protocol, and visit documentation. Propensity score (PS) matching was performed based on 20 preoperative risk variables to correct for selection bias.

Results A total of 1,522 patients were enrolled, with 1,267 in the control group and 255 in the LAA amputation group. Occurrence of POAF was compared in 243 PS-matched patient pairs. Neither the unmatched cohort (odds ratio [OR] 0.82; 95% confidence interval or CI [0.61; 1.11], p = 0.19) nor the PS-matched cohort (OR 0.94; 95% CI [0.62; 1.41], p = 0.75) showed significant differences in POAF occurrence. Subgroup analysis of sex, use of β-blockers, pulmonary disease, ejection fraction, and CHA2DS2-VASc-Score also showed no tendencies. LA volume did not change significantly (p = 0.18, 95% CI [−0.29; 1.51]).

Conclusion Surgical amputation of the LAA concomitant to CABG did not lead to LA dilation and has no significant impact on the occurrence of POAF.

Keywords

off-pump surgery - mortality - coronary artery bypass graft - arrhythmia

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Supplementary Material