Author + information
- Ayman Elbadawi,
- Odunayo Olorunfemi,
- Gbolahan O. Ogunbayo,
- Deola Saheed,
- Amole Ojo and
- Rowlens Melduni
Background: Left atrial appendage (LAA) excision is a commonly performed procedure to reduce embolic events in many patients with atrial fibrillation (AF) undergoing valvular surgeries. Our study evaluates the outcomes of LAA excision in patients undergoing valvular heart surgeries.
Methods: We queried the Nationwide Inpatient Survey Database from 1998 to 2013 and defined our study population as patients with primary ICD-9-CM diagnosis codes for AF. From this population we identified patients undergoing aortic, mitral, tricuspid or pulmonic valve replacement. We then performed a case-control matching based on the CHA2DS2VASc score of the patients in our cohort. We describe baseline characteristics and performed multivariate logistic regression analysis with stroke and Transient Ischemic Attack (TIA) as primary outcomes and mortality and length of stay as secondary outcomes.
Results: Our analysis included 652 patients with a primary diagnosis of AF who received LAA excision with valvular surgery, who were matched by CHA2VASC2 score with 652 patients who received valvular surgery without LAA excision. Patients that underwent LAA excision had significantly less TIA (0% vs. 0.6%, p=0.005), fewer in-hospital death (1.5%vs. 4.9%, p=0.001) and no difference in acute stroke (2.5% vs. 3.4%, p=0.323) compared to those with valve surgery only. LAA excision was also associated with shorter hospital stay (10.5 vs. 12.9 days, p<0.001), less ventilation time more than 72 hours (4.6% vs 7.1%, p=0.006), less pneumonia (1.3% vs 2.9%, p=0.004). The LAA excision cohort however had more pericardial effusion events (1.3% vs. 0.5%, p=0.039) but no overall difference between the two groups in major bleeding events (p=0.550). Multivariate regression analysis showed lower odds for mortality [OR: 0.41, p=0.034], association with shorter length of stay [t:-4.98; p<0.001] and lower cost of stay [t: −2.02; p<0.044] for the LAA excision group.
Conclusions: In patients with AF undergoing valvular surgeries, LAA excision could improve cardiovascular outcomes by reducing TIA, in-hospital mortality, hospital stay and ventilation time. This might occur at the expense of more pericardial effusion complications.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Miscellaneous and Surgical Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1236-077
- 2017 American College of Cardiology Foundation