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Exclusion versus preservation of the left atrial appendage in rheumatic mitral valve surgery

Authors
 Wan Kee Kim  ;  Ho Jin Kim  ;  Joon Bum Kim  ;  Sung Ho Jung  ;  Suk Jung Choo  ;  Cheol Hyun Chung  ;  Jae Won Lee 
Citation
 HEART, Vol.106(23) : 1839-1846, 2020-12 
Journal Title
HEART
ISSN
 1355-6037 
Issue Date
2020-12
Keywords
atrial arrhythmia ablation procedures ; atrial fibrillation ; mitral stenosis ; stroke
Abstract
Objectives: This study aimed to evaluate the impact of left atrial appendage exclusion on clinical outcomes in patients with atrial fibrillation (AF) undergoing rheumatic mitral surgery. Methods: We retrospectively reviewed 1226 consecutive patients with AF (54.5±11.6 years; 68.2% females) who underwent rheumatic mitral valve (MV) surgery from 1997 to 2016. The left atrial appendage was preserved in 836 (68.2%) and excluded in 390 (31.8%) patients. Surgical AF ablation was performed in 506 (60.5%) and 304 (77.9%) patients with preserved and excluded left atrial appendage, respectively. For baseline adjustment, propensity matching was used. Results: During a median follow-up of 63.4 months (IQRs, 20-111 months), there were no significant intergroup differences in the risks of mortality (2.77% vs 3.03%/patient-years) and thromboembolic events (0.91% vs 1.02%/patient-years). In the 258 pairs of propensity-score matched patients, death (2.77% vs 3.03%/patient-years) and thromboembolism (1.36% vs 0.82%/patient-years) outcomes were comparable for both groups. In a subgroup undergoing ablation (n=810), there were no significant differences in the adjusted risks of death (HR, 0.67; 95% CI, 0.34 to 1.32) and thromboembolism (HR, 0.47; 95% CI, 0.18 to 1.26). In a subgroup not undergoing ablation (n=416), however, left atrial appendage preservation tended to have higher adjusted risks for death (HR, 2.24; 95% CI, 0.98 to 5.13) and thromboembolism (HR, 4.41; 95% CI, 0.97 to 20.1). Conclusions: Left atrial appendage preservation did not seem to have greater risks of adverse clinical events in patients with AF undergoing rheumatic MV surgery particularly when ablation procedure is combined.
Full Text
https://heart.bmj.com/content/106/23/1839.long
DOI
10.1136/heartjnl-2019-316387
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Wan Kee(김완기)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182736
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