Closure of the left atrial appendage (LAA) reduces the rates of TIA/stroke in patients
in atrial fibrillation (AF) but its role in patients in sinus rhythm who undergo mitral
valve repair (MV) for leaflet prolapse remains unknown. This study examined the effects
of closing the LAA in TIA/stroke after MV repair. Our database on patients who had
MV repair for leaflet prolapse from 2000 through 2019 was reviewed. After excluding
patients at higher risk of TIA/stroke, 1050 patients in sinus rhythm were entered
into the study: 781 with open LAA and 269 with surgically closed LAA. Using a propensity
score analysis to compensate from clinical differences, 267 pairs of patients with
open and closed LAA were matched. Follow-up was truncated at 5 years because routine
closure of the LAA was performed only during recent years. The cumulative incidence
of TIA/stroke at 5 years in the entire cohort was 2.7% [95% CI 1.9, 4.0]; it was 2.9%
[95% CI 1.9, 4.4] in patients with open LAA,and 1.8% [95% CI 0.7, 4.9] in patients
with closed LAA (P = 0.53). In the matched cohorts, the cumulative incidences of TIA/stroke did not
differ significantly (match-adjusted HR [95% CI] = 0.80 [0.21, 2.98], P = 0.74), and multivariable Cox proportional hazard regression analysis also confirmed
no difference in the risk of TIA/stroke between the 2 groups (regression-adjusted
HR [95% CI] = 0.58 [0.12, 2.9], P = 0.47). This study failed to show a reduction in the risk of TIA/stroke by closing
the LAA in patients in sinus rhythm (Figure 6). Closure of the LAA during MV repair
warrants a larger and more rigorous study.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AF (atrial fibrillation), MV (mitral valve), LAA (left atrial appendage), MR (mitral regurgitation), TIA (transient ischemic attack), TEE (transesophageal echocardiography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 21, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: The authors have no conflict of interest to disclose.
This study was funded by the Division of Cardiovascular Surgery of University Health Network.
Read at the AATS 102nd Annual Meeting, May 14-17, 2022, Boston, MA.
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© 2022 Elsevier Inc. All rights reserved.
