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OBJECTIVE:
The left atrial appendage (LAA): Our most lethal human attachment? What should we do with it? An important question for surgical and interventional procedures.
We analyzed the data of patients up to one year after cardiac surgery if LAA occlusion is able to reduce postoperative death and the incidence of stroke.
METHODS: In a prospective register study a total of 396 patients (pts) with permanent atrial fibrillation (pAF) (50.5% male; LVEF 52 - 58%, Mean age 68.4 ± 9 years) were analyzed up to one year follow up. Pts (all suffering from pAF) after cardiac surgery were divided into four groups: I: cardiac operation with isolated left atrial appendage closure (LAA) n=42; II: cardiac operation with LAA closure and additional endocardial microwave ablation (EMA) n=196; III: cardiac operation with EMA without LAA closure n=71; IV: patients with cardiac operation without EMA and LAA closure n=87.
RESULTS: Overall LAA closure was done in 238 pts. One year mortality rate was significantly different between the patients who had LAA closure and/or ablation and those who had not: Group I: 9.5%; II: 12.8%; III: 7%; IV: 21.8%. In Figure 1 the incidence of stroke in the four groups is depicted. It shows a significant lower incidence of stroke (p= 0.05 to 0.01) in these patient who got their pAF treated in comparison to the control group IV. The mortality rate of those patients who suffered from a postoperative stroke was 48.5%.
CONCLUSIONS: LAA closure alone or in combination with an ablation procedure shows a significant benefit for survival and stroke prevention in the surgical treatment of pts with pAF. Therefore closure of the LAA should be recommended for all pts with atrial fibrillation who require cardiac surgery.