Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study
Abstract Background Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13019-018-0740-7 |
| _version_ | 1817993481160753152 |
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| author | Jesper Park-Hansen Susanne J.V. Holme Akhmadjon Irmukhamedov Christian L. Carranza Anders M. Greve Gina Al-Farra Robert G. C. Riis Brian Nilsson Johan S.R. Clausen Anne S. Nørskov Christina R. Kruuse Egill Rostrup Helena Dominguez |
| author_facet | Jesper Park-Hansen Susanne J.V. Holme Akhmadjon Irmukhamedov Christian L. Carranza Anders M. Greve Gina Al-Farra Robert G. C. Riis Brian Nilsson Johan S.R. Clausen Anne S. Nørskov Christina R. Kruuse Egill Rostrup Helena Dominguez |
| author_sort | Jesper Park-Hansen |
| collection | DOAJ |
| description | Abstract Background Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by left atrial appendage closure with surgery (LAACS). However, the protective effect of LAACS on the risk of cerebral ischemia following cardiac surgery remains controversial. We have studied whether LAACS in addition to open heart surgery protects against post-operative ischemic brain injury regardless of a previous AF diagnosis. Methods One hundred eighty-seven patients scheduled for open heart surgery were enrolled in a prospective, open-label clinical trial and randomized to concomitant LAACS vs. standard care. Randomization was stratified by usage of oral anticoagulation (OAC) planned to last at least 3 months after surgery. The primary endpoint was a composite of post-operative symptomatic ischemic stroke, transient ischemic attack or imaging findings of silent cerebral ischemic (SCI) lesions. Results During a mean follow-up of 3.7 years, 14 (16%) primary events occurred among patients receiving standard surgery vs. 5 (5%) in the group randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1–0.8, p = 0.02). In per protocol analysis (n = 141), 14 (18%) primary events occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1–1.0, p = 0.05). Conclusions In a real-world setting, LAACS in addition to elective open-heart surgery was associated with lower risk of post-operative ischemic brain injury. The protective effect was not conditional on AF/OAC status at baseline. Trial registration LAACS study, clinicaltrials.gov NCT02378116, March 4th 2015, retrospectively registered. |
| first_indexed | 2024-04-14T01:39:35Z |
| format | Article |
| id | doaj.art-9762b2bf547342c3a2310e1ccc9fc5cf |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-14T01:39:35Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-9762b2bf547342c3a2310e1ccc9fc5cf2022-12-22T02:19:48ZengBMCJournal of Cardiothoracic Surgery1749-80902018-05-011311810.1186/s13019-018-0740-7Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized studyJesper Park-Hansen0Susanne J.V. Holme1Akhmadjon Irmukhamedov2Christian L. Carranza3Anders M. Greve4Gina Al-Farra5Robert G. C. Riis6Brian Nilsson7Johan S.R. Clausen8Anne S. Nørskov9Christina R. Kruuse10Egill Rostrup11Helena Dominguez12Department of Cardiology, Bispebjerg and Frederiksberg University HospitalDepartment of Thoracic Surgery, RigshospitaletDepartment of Thoracic Surgery, Odense University HospitalDepartment of Thoracic Surgery, RigshospitaletDepartment of Cardiology, Bispebjerg and Frederiksberg University HospitalDepartment of Radiology, Herlev Gentofte University HospitalDepartment of Radiology, Bispebjerg and Frederiksberg HospitalDepartment of Cardiology, Hvidovre University HospitalDepartment of Cardiology, Bispebjerg and Frederiksberg University HospitalDepartment of Cardiology, Bispebjerg and Frederiksberg University HospitalDepartment Neurology, Neurovascular Research Unit, Herlev Gentofte HospitalMental Health Center GlostrupDepartment of Cardiology, Bispebjerg and Frederiksberg University HospitalAbstract Background Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by left atrial appendage closure with surgery (LAACS). However, the protective effect of LAACS on the risk of cerebral ischemia following cardiac surgery remains controversial. We have studied whether LAACS in addition to open heart surgery protects against post-operative ischemic brain injury regardless of a previous AF diagnosis. Methods One hundred eighty-seven patients scheduled for open heart surgery were enrolled in a prospective, open-label clinical trial and randomized to concomitant LAACS vs. standard care. Randomization was stratified by usage of oral anticoagulation (OAC) planned to last at least 3 months after surgery. The primary endpoint was a composite of post-operative symptomatic ischemic stroke, transient ischemic attack or imaging findings of silent cerebral ischemic (SCI) lesions. Results During a mean follow-up of 3.7 years, 14 (16%) primary events occurred among patients receiving standard surgery vs. 5 (5%) in the group randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1–0.8, p = 0.02). In per protocol analysis (n = 141), 14 (18%) primary events occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1–1.0, p = 0.05). Conclusions In a real-world setting, LAACS in addition to elective open-heart surgery was associated with lower risk of post-operative ischemic brain injury. The protective effect was not conditional on AF/OAC status at baseline. Trial registration LAACS study, clinicaltrials.gov NCT02378116, March 4th 2015, retrospectively registered.http://link.springer.com/article/10.1186/s13019-018-0740-7Atrial fibrillationHeart surgeryLeft atrial appendage closureStroke |
| spellingShingle | Jesper Park-Hansen Susanne J.V. Holme Akhmadjon Irmukhamedov Christian L. Carranza Anders M. Greve Gina Al-Farra Robert G. C. Riis Brian Nilsson Johan S.R. Clausen Anne S. Nørskov Christina R. Kruuse Egill Rostrup Helena Dominguez Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study Journal of Cardiothoracic Surgery Atrial fibrillation Heart surgery Left atrial appendage closure Stroke |
| title | Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study |
| title_full | Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study |
| title_fullStr | Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study |
| title_full_unstemmed | Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study |
| title_short | Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study |
| title_sort | adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history the laacs randomized study |
| topic | Atrial fibrillation Heart surgery Left atrial appendage closure Stroke |
| url | http://link.springer.com/article/10.1186/s13019-018-0740-7 |
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