Clinical management after surgical left atrial appendage exclusion.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiothoracic Surgery Pub Date : 2025-03-18 DOI:10.1186/s13019-025-03378-x

Prashant D Bhave, Karanpreet K Dhaliwal, Sneha Chebrolu, Jonathan Brock, Matthew J Singleton, Karl M Richardson

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引用次数: 0

Abstract

Background: Surgical left atrial appendage (LAA) closure is an increasingly utilized approach to mitigate the risk of cardioembolic stroke in patients with atrial fibrillation (AF). Consensus is lacking regarding optimal stroke prevention management after surgical LAA management.

Objective: To elucidate real world clinical management of anticoagulation in patients undergoing surgical LAA management.

Methods: Over a 7-year period at a single center, 458 participants carried a diagnosis of AF and underwent surgical exclusion of their LAA during concomitant cardiac surgery. Follow-up was catalogued via retrospective chart review; median follow-up was 2 years. Successful LAA ligation was defined as maximal stump depth < 1.0 cm by transesophageal echocardiography (TEE) without distal leak.

Results: Among 458 patients, 299 were discharged on OAC (142 DOAC and 157 warfarin). Of these, 31% (94/299) had a follow-up TEE. Among those without a TEE, 32% (65/205) were taken off OAC; among those who underwent TEE, 59% (55/94) were taken off OAC. Using a logistic regression model, there was no relationship between age, sex, CHA₂DS₂-VASc score, or creatinine and the probability of coming off of OAC. Among the 94 patients discharged on OAC who had a follow-up TEE:10 were unable to assess adequacy of closure, 69 were successful, and 15 showed unsuccessful closure. In the group with imaging confirmed successful exclusion of their LAA, 67% (46/69) were taken off their oral anticoagulation, with cessation occurring after the TEE in 93% (43/46) of those patients.

Conclusion: Clinical management after surgical LAA management, particularly with regard to LAA imaging and OAC continuation, is highly heterogeneous.

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左心耳切除术后的临床处理。

背景：手术左心房附件（LAA）关闭是一种越来越多地用于减轻心房颤动（AF）患者心栓性卒中风险的方法。对于LAA手术后的最佳卒中预防管理缺乏共识。目的：探讨LAA手术患者的抗凝治疗方法。方法：在7年的时间里，在一个单一的中心，458名参与者被诊断为房颤，并在伴随的心脏手术中接受了手术排除他们的LAA。通过回顾性图表审查对随访进行分类；中位随访时间为2年。结果：458例患者中，299例使用OAC出院（142例DOAC， 157例华法林）。其中，31%（94/299）有随访TEE。在没有TEE的患者中，32%（65/205）停止了OAC；在接受TEE治疗的患者中，59%（55/94）停止了OAC治疗。使用逻辑回归模型，年龄、性别、CHA2DS2-VASc评分或肌酐与OAC脱落概率没有关系。在94例经OAC出院并随访TEE的患者中：10例无法评估闭合是否充分，69例成功，15例闭合不成功。在影像学证实LAA排除成功的组中，67%（46/69）的患者停止口服抗凝治疗，其中93%（43/46）的患者在TEE后停止使用抗凝治疗。结论：手术后LAA的临床处理，特别是LAA成像和OAC的延续，是高度不一致的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiothoracic Surgery 医学-心血管系统

CiteScore

2.50

自引率

6.20%

发文量

286

审稿时长

4-8 weeks

期刊介绍： Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.