Does left atrial appendage ligation during coronary bypass surgery decrease the incidence of postoperative stroke?

Yen-Yi Juo; Katherine Lee Bailey; Young-Ji Seo; Esteban Aguayo; Peyman Benharash

doi:10.1016/j.jtcvs.2018.02.089

Does left atrial appendage ligation during coronary bypass surgery decrease the incidence of postoperative stroke?

J Thorac Cardiovasc Surg. 2018 Aug;156(2):578-585. doi: 10.1016/j.jtcvs.2018.02.089. Epub 2018 Mar 12.

Authors

Yen-Yi Juo¹, Katherine Lee Bailey², Young-Ji Seo², Esteban Aguayo², Peyman Benharash³

Affiliations

¹ Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, Calif; Department of Surgery, George Washington University, Washington, DC.
² David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif.
³ Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, Calif; Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, Calif. Electronic address: Pbenharash@mednet.ucla.edu.

PMID: 29615335
DOI: 10.1016/j.jtcvs.2018.02.089

Abstract

Objective: The study objective was to evaluate the association between surgical left atrial appendage ligation and in-hospital stroke incidence after coronary artery bypass grafting among patients with atrial fibrillation.

Methods: A retrospective cohort study was performed by using the Nationwide Inpatient Sample between 2008 and 2014. All atrial fibrillation patients who underwent coronary artery bypass graft were included and categorized as left atrial appendage ligation or control group. Propensity score-weighted regression analyses were performed to assess the impact of left atrial appendage ligation on stroke incidence.

Results: A total of 234,642 patients were identified, among whom 20,664 (8.81%) received concomitant left atrial appendage ligation. The national postoperative stroke incidence was 0.92%. Results of the propensity-weighted regression analysis showed no significant association between LAA ligation and control with regard to postoperative stroke (odds ratio [OR], 0.83; confidence interval [CI], 0.57-1.22; P = .35), pericardial complications (OR, 1.15; CI, 0.88-1.49; P = .31), hemorrhage and/or hematoma (OR, 1.08; CI, 0.99-1.17; P = .07), mortality (OR, 1.29; CI, 0.99-1.68; P = .06), and length of stay (coefficient -0.21; CI, -0.44-0.02; P = .08). There was no specific CHA2DS2VASC score cutoff above which left atrial appendage ligation was demonstrated to have lower postoperative stroke incidence.

Conclusions: The postoperative stroke risk after coronary artery bypass grafting was low at approximately 1% among patients with atrial fibrillation in the United States. Concomitant left atrial appendage ligation was not associated with lower postoperative stroke risk.

Keywords: atrial fibrillation; coronary artery bypass graft; left atrial appendage; stroke.

MeSH terms

Aged
Atrial Appendage / surgery*
Coronary Artery Bypass* / adverse effects
Coronary Artery Bypass* / statistics & numerical data
Female
Humans
Incidence
Ligation* / adverse effects
Ligation* / statistics & numerical data
Male
Postoperative Complications / epidemiology*
Retrospective Studies
Risk Factors
Stroke* / epidemiology
Stroke* / etiology