Ligation of the left atrial appendage during coronary artery bypass grafting in patients with atrial fibrillation
Abstract
Aim: to evaluate the effect of the left atrial appendage (LAA) ligation on the development of ischemic stroke (IS) and overall mortality in the early and long-term postoperative period in patients with atrial fibrillation (AF) during off pump coronary artery bypass grafting (OPCAB).
Material and methods. A retrospective analysis of the results of OPCAB in 125 patients with coronary heart disease (CHD) and AF who were operated from May 2009 to November 2013 at the Federal Center for Cardiovascular Surgery (Astrakhan, Russia) was performed. A study included 108 men (86.4%) and 17 women (13.6%) with an average age of 64±7 years (95% CI: 61–65). Exclusion criteria: acute coronary syndrome, conversion, redo operation, thrombosis of the left heart, hemodynamically significant lesions of the brachiocephalic vessels, concomitant pathology of the heart, requiring intervention. Patients were divided into two groups: group I – 57 patients who underwent epicardial ligation of the LAA, group II (control) – 68 patients without ligation. Median follow-up (Me) was 41 (22–61) months.
Results. There was no statistically significant difference in the frequency of ischemic strokes and deaths in both groups during hospital stay (in group I the number of strokes was 0%, in group II – 5.9%, p=0.1; the number of deaths in group I – 0%, in group II – 4.4%, p=0.2).
We established a statistically significant difference in the number of ischemic strokes in the longterm postoperative period (no strokes in group I and 17.6% in group II, p<0,001)), while no statistically significant difference in mortality was found (group I – 5.3%, group II – 16.2%, p=0.08).
Conclusion. The frequency of ischemic stroke was statistically lower in the group with LAA ligation than in the control group in the long-term postoperative period. At the same time, we found no statistically significant difference in number of strokes in the early postoperative period. Overall mortality was the same in both groups within the entire follow-up period.
Keywords:atrial fibrillation, LAA, stroke, coronary artery bypass grafting
For citation: Enginoev S.T., Kozmin D.Yu., Magomedov G.M., Makeev S.A., Ilov N.N., Stompel D.R., Chernov I.I., Tara- sov D.G. Ligation of the left atrial appendage during coronary artery bypass grafting in patients with atrial fibrillation. Clin Experiment Surg. Petrovsky J. 2019; 7 (3): 88–93. doi: 10.24411/2308-1198-2019-13010 (in Russian)
Received 11.02.2019. Accepted 25.07.2019.
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