Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years afte
- PDF / 878,441 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 64 Downloads / 145 Views
RESEARCH ARTICLE
Open Access
Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study Jesper Park-Hansen1,2, Susanne J.V. Holme3, Akhmadjon Irmukhamedov4, Christian L. Carranza3, Anders M. Greve1,2, Gina Al-Farra5, Robert G. C. Riis6, Brian Nilsson7, Johan S.R. Clausen1,2, Anne S. Nørskov1,2, Christina R. Kruuse8, Egill Rostrup9 and Helena Dominguez1,2*
Abstract Background: Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by left atrial appendage closure with surgery (LAACS). However, the protective effect of LAACS on the risk of cerebral ischemia following cardiac surgery remains controversial. We have studied whether LAACS in addition to open heart surgery protects against post-operative ischemic brain injury regardless of a previous AF diagnosis. Methods: One hundred eighty-seven patients scheduled for open heart surgery were enrolled in a prospective, openlabel clinical trial and randomized to concomitant LAACS vs. standard care. Randomization was stratified by usage of oral anticoagulation (OAC) planned to last at least 3 months after surgery. The primary endpoint was a composite of postoperative symptomatic ischemic stroke, transient ischemic attack or imaging findings of silent cerebral ischemic (SCI) lesions. Results: During a mean follow-up of 3.7 years, 14 (16%) primary events occurred among patients receiving standard surgery vs. 5 (5%) in the group randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1–0.8, p = 0.02). In per protocol analysis (n = 141), 14 (18%) primary events occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1–1.0, p = 0.05). Conclusions: In a real-world setting, LAACS in addition to elective open-heart surgery was associated with lower risk of post-operative ischemic brain injury. The protective effect was not conditional on AF/OAC status at baseline. Trial registration: LAACS study, clinicaltrials.gov NCT02378116, March 4th 2015, retrospectively registered. Keywords: Atrial fibrillation, Heart surgery, Left atrial appendage closure, Stroke
* Correspondence: [email protected] 1 Department of Cardiology, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark 2 Department of Biomedicine, University of Copenhagen, Copenhagen, Denmark Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original autho
Data Loading...
