The Journal of Thoracic and Cardiovascular Surgery
AdultLeft atrial appendage closure during mitral repair in patients without atrial fibrillation
Graphical abstract
Section snippets
Data Sources
A retrospective cohort analysis was conducted using an institutional registry with prospective clinical follow-up linked to statewide discharge and vital statistics databases, to analyze 1036 consecutive patients undergoing robotic mitral repair between 2005 and 2020. Record linkage to the Office for State Public Health Departments of California was performed using probabilistic linkage with the following variables: birth date, patient zip code, admission date, discharge date, race, and sex,
Procedural Outcomes
Surgical practice changed in 2014: 5.3% (15 out of 284) patients without recent AF before 2014 versus 86.7% (416 out of 480) after 2014 underwent LAA closure at the time of mitral repair. This means that the 2 treatment groups were very similar with no significant differences in clinical baseline characteristics except older median age in patients receiving LAA closure (63 vs 57.5 years; P < .001). The overall mitral repair rate was 99.5% (n = 760), and there were 3 in-hospital mortalities.
Discussion
These findings suggest that routine suture closure of the LAA during mitral surgery in patients without AF appears safe and may be associated with a reduced risk of late stroke in a retrospective analysis (Figure 2). However, without supporting randomized data it is premature to recommend routine prophylactic LAA closure at the time of mitral repair.
The rationale for routine LAA closure in patients without recent AF before mitral repair is based on predominantly anecdotal data suggesting high
Conclusions
In this retrospective analysis of patients without recent AF undergoing mitral repair, LAA closure could be performed safely in most patients, and may be associated with a decreased risk of subsequent strokes, although the overall stroke rates were low. These data may support the rationale for a randomized trial. However, a pragmatic trial design, or emulated trial in a large dataset may be most feasible given the number of patients required for adequate power. Until then, there is insufficient
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Cited by (1)
Commentary: To ligate or not to ligate the left atrial appendage at the time of robotic mitral valve repair? That is still the question
2023, Journal of Thoracic and Cardiovascular Surgery
Drs Roach and Chen are supported by a grant from the National Institutes of Health for advanced heart disease research (T32HL116273).
This study was approved by the institutional review board of Cedars-Sinai Medical Center effective 12/5/2019 (protocol number: STUDY00000332), as well as the California Department of Public Health, and The Office for State Public Health Departments of California. The approval included a waiver of informed consent.