Safety of left atrial appendage amputation in cardiac surgery patients without atrial fibrillation.

Abstract

Background: Left atrial appendage amputation (LAAA) lowers stroke risk in patients with atrial fibrillation (AF), but its safety and functional implications in non-AF patients are uncertain.

Objective: To assess early postoperative safety of LAAA in non-AF patients undergoing cardiac surgery.

Methods: This retrospective cohort study included 434 patients without AF (CHA2DS2-VASc≥2) who underwent elective cardiac surgery at two centers (2015-2018). We compared 150 patients who underwent LAAA as part of the PREDICT-AF study, with 284 patients who declined participation and did not undergo LAAA. The primary endpoint was a composite of major complications and supraventricular tachycardias within 30 days. Secondary outcomes included individual complications, arrhythmias and surrogate markers for fluid overload (weight changes, diuretic use, blood pressure and chest x-ray congestion). Repeated measures were compared using linear mixed-effects models. 1:1 Propensity score matching was performed to assess outcomes in balanced groups.

Results: The LAAA group had more males (87% vs. 73%;p=0.001) and were heavier (86kg [CI:80-92] vs. 82kg [CI:72-91];p=0.001). No significant differences were observed in the primary endpoint (47% vs. 41%;p=0.321) or postoperative AF (38% vs. 32%;p=0.225). Atrial tachycardias were uncommon but more frequent in the LAAA cohort (4% vs. 0.4%;p=0.014). Procedural times and markers for fluid overload did not differ. PSM confirmed no important differences between cohorts.

Conclusion: Concomitant LAAA was not associated with increased surgical complications, postoperative AF, or fluid overload in patients without a history of AF. These findings suggest LAAA may be a safe strategy for stroke prevention in patients undergoing cardiac surgery.