Eitezaz Mahmood1, Robina Matyal2, Feroze Mahmood2, Xinling Xu2, Aidan Sharkey2, Omar Chaudhary2, Sadia Karani2, Kamal R Khabbaz3. 1. Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Internal Medicine, North Shore University Hospital, Manhasset, NY. 2. Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 3. Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Abstract
Background: The objective of this study was to evaluate the impact of LAA exclusion on short term outcomes in patients with atrial fibrillation undergoing isolated coronary artery bypass graft (CABG) surgery. Methods: We queried the 2010-2014 National Readmissions Database (NRD) for patients who underwent coronary artery bypass graft repair with and without left atrial appendage ligation using ICD-9 procedure codes (ICD-9: 36.1xx). Only patients with a history of atrial fibrillation were included in our analysis. The primary outcome of our study was 30-day readmissions following discharge. Secondary outcomes were in hospital mortality and stroke. To assess the postoperative outcomes, we utilized multivariate logistic regression models to adjust for clinical and demographic covariates. Results: In total we analyzed 253,287 CABG patients, 7.0% of whom received LAA closure. LAA exclusion was associated with a greater risk of postoperative respiratory failure (8.2% vs. 6.2%, p <.0001), acute kidney injury (21.8% vs. 18.5%, p <.0001), but did not significantly change the rate of blood transfusions or occurrence of cardiac tamponade. LAA exclusion was associated with a non-significant reduction in stroke (7.9% vs. 8.6%, p = .12), no difference in in-hospital mortality (2.2% vs. 2.2% p = .99), and a greater risk of 30-day readmission (16.0% vs. 9.6%, p < .0001) After covariate adjustment, LAA ligation remained a significant predictor of 30-day readmission (OR: 1.640, 95% CI: 1.603 - 1.677, p <.0001). Conclusions: LAA exclusion during isolated CABG in patients with AF is associated with a higher rate of 30-day readmission. Post-operative measures to mitigate the loss of the hormonal and hemodynamic effects of the LAA may increase the therapeutic benefit of this procedure.
Background: The objective of this study was to evaluate the impact of LAA exclusion on short term outcomes in patients with atrial fibrillation undergoing isolated coronary artery bypass graft (CABG) surgery. Methods: We queried the 2010-2014 National Readmissions Database (NRD) for patients who underwent coronary artery bypass graft repair with and without left atrial appendage ligation using ICD-9 procedure codes (ICD-9: 36.1xx). Only patients with a history of atrial fibrillation were included in our analysis. The primary outcome of our study was 30-day readmissions following discharge. Secondary outcomes were in hospital mortality and stroke. To assess the postoperative outcomes, we utilized multivariate logistic regression models to adjust for clinical and demographic covariates. Results: In total we analyzed 253,287 CABG patients, 7.0% of whom received LAA closure. LAA exclusion was associated with a greater risk of postoperative respiratory failure (8.2% vs. 6.2%, p <.0001), acute kidney injury (21.8% vs. 18.5%, p <.0001), but did not significantly change the rate of blood transfusions or occurrence of cardiac tamponade. LAA exclusion was associated with a non-significant reduction in stroke (7.9% vs. 8.6%, p = .12), no difference in in-hospital mortality (2.2% vs. 2.2% p = .99), and a greater risk of 30-day readmission (16.0% vs. 9.6%, p < .0001) After covariate adjustment, LAA ligation remained a significant predictor of 30-day readmission (OR: 1.640, 95% CI: 1.603 - 1.677, p <.0001). Conclusions: LAA exclusion during isolated CABG in patients with AF is associated with a higher rate of 30-day readmission. Post-operative measures to mitigate the loss of the hormonal and hemodynamic effects of the LAA may increase the therapeutic benefit of this procedure.
Authors: Jurij M Kalisnik; Giuseppe Santarpino; Andrea I Balbierer; Janez Zibert; Ferdinand A Vogt; Matthias Fittkau; Theodor Fischlein Journal: J Clin Med Date: 2022-06-14 Impact factor: 4.964
Authors: Nadia H Bakir; Ali J Khiabani; Robert M MacGregor; Meghan O Kelly; Laurie A Sinn; Richard B Schuessler; Hersh S Maniar; Spencer J Melby; Mohammad A Helwani; Ralph J Damiano Journal: J Thorac Cardiovasc Surg Date: 2021-01-23 Impact factor: 6.439