Cardiovascular Outcomes With Surgical Left Atrial Appendage Exclusion in Patients With Atrial Fibrillation Who Underwent Valvular Heart Surgery (from the National Inpatient Sample Database)

Abstract

Left atrial appendage (LAA) exclusion is a commonly performed procedure to reduce the embolic events in patients with atrial fibrillation (AF) who underwent cardiac surgeries. Our study aimed to evaluate the in-hospital outcomes of LAA exclusion in patients with AF who underwent valvular heart surgeries. We queried the Nationwide Inpatient Sample Database from 1998 to 2013 for patients with the International Classification of Diseases, Ninth Edition, Clinical Modification, diagnosis codes for AF and underwent any valvular heart surgery. We then performed a case-control matching based on the CHA2DS2VASc score for those who underwent LAA exclusion versus those who did not. Primary outcome was the incidence of in-hospital cerebrovascular events, whereas the secondary outcomes included all-cause mortality, length of hospital stay, and bleeding. Our analysis included 1,304 patients. Patients who underwent LAA exclusion had significantly less incidence of cerebrovascular events (2.5% vs 4.6%, p= 0.04), in-hospital death (1.5% vs 4.9%, p= 0.001), and shorter hospital stay (10.5 vs 12.9days, p <0.01). The LAA exclusion cohort had more incidence of pericardial effusion (1.3% vs 0.5%, p= 0.04) but no difference in bleeding events (p= 0.55). In conclusion, in patients with AF who underwent valvular surgeries, LAA exclusion may be associated with lower in-hospital cerebrovascular events and mortality and shorter hospital stay.