Surgical left atrial appendage occlusion in patients with atrial fibrillation undergoing mechanical heart valve replacement  

作　　者：Ye Zheng Chen-Fei Rao Si-Peng Chen Li He Jian-Feng Hou Zhe Zheng 

机构地区：[1]Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China [2]Information Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China.

出　　处：《Chinese Medical Journal》2020年第16期1891-1899,共9页中华医学杂志（英文版）

基　　金：Supported by the grants from the Ministry of Science and Technology of China and the Prevention and Control Project of Major Chronic Non-infection Disease during the 13th 5-year plan period(No:2016YFC1302000);the Beijing Municipal Science and Technology Commission(D171100002917001).

摘　　要：Background:Surgical left atrial appendage occlusion(SLAAO)may be associated with a lower risk of thromboembolism in patientswith atrial fibrillation undergoing cardiac surgery.However,evidence regarding the effectiveness of SLAAO in patients undergoingmechanical heart valve replacement(MHVR)is lacking.Therefore,we aimed to evaluate the association between SLAAO and thecardiovascular outcomes in patients with atrial fibrillation undergoing MHVR.Methods:We retrospectively analyzed data for 497 patients with atrial fibrillation;27.6%of the patients underwent SLAAO,andthe remainder of the patients did not(No-SLAAO group).The primary outcome was a composite of ischemic stroke,systemicembolism,and all-cause mortality.Cumulative event-free survival rates were estimated using Kaplan-Meier curves,and weperformed multivariate Cox analyses to evaluate the association between SLAAO and outcomes.We used one-to-one propensityscore matching to balance patients’baseline characteristics,and analyzed 120 matching pairs.Results:Five patients died within 30 days postoperatively,and there were no significant differences between the two groupsregarding in-hospital complications(all P>0.05).After a median follow-up of 14 months,14 primary events occurred.Kaplan-Meier curves showed no difference in the cumulative incidence of freedom from the primary outcome(log-rank P=0.830),hemorrhagic events(log-rank P=0.870),and the secondary outcome(log-rank P=0.730),between the two groups.MultivariableCox proportional hazards regression analysis showed no association between SLAAO and any outcome(all P>0.05).Afterpropensity score matching,cardiopulmonary bypass time and aortic cross-clamp time,and the postoperative length of stay weresignificantly longer in the SLAAO group(all P<0.05);results were similar to the unadjusted analyses.Conclusions:Concomitant SLAAO and MHVR was associated with longer length of stay,and cardiopulmonary bypass time andaortic cross-clamp time,but was not associated with additional protective effects against thromboembo

关 键 词：Atrial fibrillation Heart valve prosthesis implantation Propensity score 

分 类 号：R654.2[医药卫生—外科学]