Left Atrial Appendage Occlusion With Left Ventricular Assist Device Decreases Thromboembolic Events

Ann Thorac Surg. 2019 Apr;107(4):1181-1186. doi: 10.1016/j.athoracsur.2018.09.004. Epub 2018 Oct 23.

Abstract

Background: Thromboembolic events (TEs) are common adverse events with continuous-flow left ventricular assist devices (LVADs). Left atrial appendage occlusion (LAAO) is commonly performed at the time of a cardiac operation. The effect of LAAO on TEs in LVAD patients remains unknown.

Methods: All patients receiving a first LVAD implantation between January 2013 and January 2014 were reviewed. TEs included device thrombosis and ischemic cerebrovascular accidents. The incidence of TEs with respect to LAAO was evaluated using Kaplan-Meier and Cox proportional hazards analyses.

Results: The analysis included 102 patients, 36 of whom received LAAO and 66 did not. LAAO patients were an average age of 60 years, and 69.4% were men. Non-LAAO patients were an average age of 59.3 years, and 71.2% were men. There were no significant differences in characteristics other than history of coronary artery bypass grafting (8.3% of LAAO vs 44% of non-LAAO, p = 0.0005). Preoperative atrial fibrillation was present in 19 LAAO patients (52.7%) and in 36 non-LAAO patients (54.5%; p = 1.0). Patients were monitored for a median of 306 days. TEs occurred in 3 LAAO patients (1 device thrombosis and 2 cerebrovascular accidents) compared with 15 non-LAAO patients (5 device thromboses and 11 cerebrovascular accidents, p = 0.049). In a Cox hazards analysis including age, sex, hypertension, and atrial fibrillation, LAAO demonstrated a decreased risk of TE (hazard ratio, 0.27; 95% confidence interval, 0.08 to 0.95; p = 0.04).

Conclusions: In patients undergoing LVAD implantation, LAAO is associated with reduced TEs, and this effect may be independent of atrial fibrillation. A prospective randomized study to examine the efficacy LAAO in prevention of TE is needed to confirm these findings.

Publication types

  • Comparative Study

MeSH terms

  • Academic Medical Centers
  • Age Factors
  • Aged
  • Atrial Appendage / pathology
  • Atrial Appendage / surgery*
  • Atrial Fibrillation / surgery
  • Cause of Death*
  • Cohort Studies
  • Equipment Failure
  • Female
  • Follow-Up Studies
  • Heart-Assist Devices / adverse effects*
  • Humans
  • Illinois
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Postoperative Complications / mortality
  • Postoperative Complications / prevention & control
  • Proportional Hazards Models
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Survival Analysis
  • Thromboembolism / etiology
  • Thromboembolism / mortality
  • Thromboembolism / prevention & control*
  • Treatment Outcome