Surgical strategy for atrial fibrillation to prevent stroke in patients undergoing cardiac surgery
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ORIGINAL ARTICLE
Surgical strategy for atrial fibrillation to prevent stroke in patients undergoing cardiac surgery Masaaki Ryomoto1 · Taichi Sakaguchi1 · Naosumi Sekiya1 · Hisashi Uemura1 · Mitsuhiro Yamamura1 · Ayaka Sato1 Received: 3 August 2020 / Accepted: 11 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective The aim of this study was to compare outcomes of the full maze procedure with left atrial appendage closure (LAAc) as concomitant procedures for atrial fibrillation (AF) in patients undergoing cardiovascular surgery. Methods A total of 151 patients (88 men, 62 women) underwent elective AF surgery concomitantly with cardiovascular surgery from April 2005 to December 2019. The mean age at time of operation was 70 years and the mean follow-up period was 5.2 ± 3.8 years. Patients were divided into two groups according to the procedure performed: the maze group (n = 87) and the LAAc group (n = 63). Results Patients in the LAAc group were significantly older and had more comorbidities than those in the maze group. The operative mortality rate was significantly higher in the LAAc group. There was no difference in the rate of freedom from cardiac-related death between the groups (p = 0.86). Furthermore, there was no difference in the 5-year rate of freedom from thromboembolic stroke between the maze group and the LAAc group (p = 0.17). However, the 5-year rate of freedom from heart failure was significantly higher in the maze group compared with the LAAc group (100% vs. 86% ± 6%, respectively; p = 0.006). Conclusions Patients undergoing the maze procedure had good operative and long-term results, suggesting that this procedure should be performed if indicated. Concomitant LAAc may be effective for preventing thromboembolic stroke in patients with AF if they have no indication for the maze procedure. Keywords Atrial fibrillation · Arrhythmia · Thrombosis · Stroke · Left atrial appendage
Introduction Atrial fibrillation (AF) is a common symptomatic arrhythmia that can cause serious complications including thromboembolic (TE) stroke. Among patients with cardiovascular disease, the mortality rate was reported to be twice as high in patients with chronic AF compared with those without [1]. The left atrial appendage (LAA) plays a pivotal role in the formation of thrombi, which can cause stroke or systemic embolism [2]. After appropriate patient selection, the bilateral maze procedure is effective for patients with AF and is now a Class IIa recommendation as a concomitant procedure in the European and United States guidelines. The
incidence of postoperative stroke is dramatically reduced in patients who receive this procedure. The reason for the low postoperative stroke rate relates to conversion to sinus rhythm and LAA closure (LAAc) [3]. However, concomitant LAAc in patients with AF remains a Class IIb recommendation according to a report by the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Soc
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