Effects of left atrial appendage surgical treatment on the incidence of ischemic cerebrovascular accidents in patients with atrial fibrillation undergoing cardiac surgery

Abstract Background We sought to assess different surgical methods for left atrial appendage treatment to determine whether any could reduce the incidence of AF related long-term ischemic cerebrovascular accidents. Methods A total of 1243 patients were treated with left atrial appendage, 107 patients (8.6%) were lost to follow-up and were excluded. The primary outcome was the long-term incidence of ischemic cerebrovascular events (i.e, ischemic stroke, excluding Transient Ischemic Attack) and all-cause mortality. Results Of the 1136 patients, a total of 37 (3.3%) patients suffered from ischemic cerebrovascular events. The 1-year, 5-year and 10-year free from long-term ischemic cerebrovascular events of the left atrial appendage extracardiac ligation group were 99.7%, 94.0% and 90.8% respectively. The 1-year, 5-year and 10-year survival rates of the LAA intracardiac suture group were 99.7%, 94.6% and 93.6% respectively. There was a significant difference between the LAA extracardiac ligation group and left atrial appendage excision group(P = 0.041). 17 (4.6%) patients had long-term ischemic cerebrovascular events in the left atrial appendage extracardiac ligation group (1.1% per year), 14 (3.5%) in the LAA intracardiac suture group (0.9% per year), and 6 (1.7%) in the LAA excision group (0.44% per year). left atrial appendage excision can reduce the occurrence of long-term thrombotic stroke compared with left atrial appendage extracardiac ligation (95%CI 1.09-9.26, P=0.035). Conclusion For patients with atrial fibrillation, the removal of the left atrial appendage can effectively prevent stroke caused by AF.