Surgical left atrial appendage occlusion in patients with left ventricular assist device.

IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2022-04-01 Epub Date: 2022-03-02 DOI:10.1111/pace.14471
Jakrin Kewcharoen, Kuldeep Shah, Rahul Bhardwaj, Tahmeed Contractor, Mohit K Turagam, Ravi Mandapati, Dhanunjaya Lakkireddy, Jalaj Garg
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引用次数: 2

Abstract

Background: Thromboembolic (TE) events are among the most common and devastating adverse events in patients with continuous-flow left ventricular assist device (cf-LVAD). Given the high burden of AF among cf-LVAD patients, we sought to evaluate the effect of concomitant surgical LAAO in patients receiving cf-LVAD.

Methods: A systematic search using electronic databases was performed using the keywords: "left atrial appendage occlusion" and "left ventricular assist device." Statistical analysis was performed using metapackage for R version 4.0 and Rstudio version 1.2. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data between two groups. The primary outcomes included: (a) stroke; (b) LVAD pump thrombosis; (c) all-cause mortality RESULTS: Three studies with a total of 305 patients (LAAO = 68 and No-LAAO = 237) were included in the analysis. HeartMate II (39%) and Heartware (27.5%) were the two most common cf-LVADs utilized, while only 5% received HeartMate III. At a mean follow up of 1.47 years, LAAO group had a lower risk of stroke (8.8% vs. 15.2%, RR 0.64; 95% CI 0.28-1.49), LVAD pump thrombosis (1.5% vs. 3.8%, RR 0.28; 95% CI 0.05-1.55) and all-cause mortality (5.9% vs. 20.2%, RR 0.69; 95% CI 0.19-2.52) when compared with no-LAAO group, but the difference did not reach statistical significance.

Conclusion: Concomitant surgical LAAO at the time of cf-LVAD implantation demonstrated a trend toward positive outcomes and was not associated with adverse outcomes during the follow-up period, though the results were not statistically significant.

手术左心耳闭塞患者的左室辅助装置。
背景:血栓栓塞(TE)事件是连续血流左心室辅助装置(cf-LVAD)患者最常见和最具破坏性的不良事件之一。鉴于cf-LVAD患者房颤负担高,我们试图评估合并手术LAAO对cf-LVAD患者的影响。方法:以“左心耳闭塞”和“左室辅助装置”为关键词,在电子数据库中进行系统检索。使用R 4.0和Rstudio 1.2的元包进行统计分析。采用Mantel-Haenszel风险比(RR)随机效应模型对两组数据进行汇总。主要结局包括:(a)卒中;(b)左室辅助泵血栓形成;(c)全因死亡率结果:3项研究共纳入305例患者(LAAO = 68, No-LAAO = 237)。HeartMate II(39%)和Heartware(27.5%)是使用最多的两种cf- lvad,而只有5%的人使用HeartMate III。平均随访1.47年,LAAO组卒中风险较低(8.8% vs. 15.2%, RR 0.64;95% CI 0.28-1.49), LVAD泵血栓形成(1.5%比3.8%,RR 0.28;95% CI 0.05-1.55)和全因死亡率(5.9% vs. 20.2%, RR 0.69;95% CI 0.19-2.52),与无laao组比较,差异无统计学意义。结论:在随访期间,cf-LVAD植入时合并手术LAAO倾向于阳性结局,与不良结局无相关性,但结果无统计学意义。
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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