060CONCOMITANT SURGICAL CLOSURE OF THE LEFT ATRIAL APPENDAGE IN PATIENTS WITH ATRIAL FIBRILLATION REDUCES RISK FOR POSTOPERATIVE THROMBO-EMBOLIC EVENTS AND IMPROVES SURVIVAL

Objectives: The left atrial appendage (LAA) has been considered to be the “most lethal human attachment”. The present study sought to evaluate the impact of surgical LAA closure in patients with atrial fibrillation (AF) undergoing cardiac surgery on postoperative thrombo-embolic events and outcome. Methods: A prospective register study enrolled a total of 396 patients with permanent AF undergoing cardiac surgery. Beneath primary cardiac surgery, concomitant procedures were isolated LAA closure (Group I; n = 42), isolated microwave ablation (Group II; maze; n = 71), combined maze and LAA closure (Group III; n = 196). The control group consisted of 87 patients without concomitant maze or LAA closure. One-year follow-up was completed in all patients. End-points were thrombo-embolic events and death from any cause. Results: Surgery consisted of coronary artery bypass grafting (CABG, 24.2%), aortic valve replacement (19.7%), mitral valve repair/replacement (35.1%) and tricuspid repair (13.6%). The logistic EuroSCORE was comparable between the treatment (LAA and/or maze) and control group (6.8 ± 2.5 vs 6.7 ± 3.0%; P = n.s.). Overall incidence of thrombo-embolic events in all patients was 9% with an associated mortality of 41.8%. In the 238 patients receiving concomitant LAA closure, overall incidence of thrombo-embolic events in patients with LAA closure was 6.3% compared with 19.5% in the control group (P < 0.001). Death from any cause occurred in 12.2% of the patients receiving LAA closure compared with 21.8% in the control group (P < 0.01). Conclusion: LAA closure alone or in combination with maze provided a significantly reduced rate of thrombo-embolic events and improved survival after 1 year of follow-up. Therefore closure of the LAA should be recommended for all patients with atrial fibrillation undergoing cardiac surgery.