Seguridad de la exclusión quirúrgica del apéndice auricular izquierdo en pacientes con fibrilación auricular sometidos a cirugía valvular mitral

Abstract

Introduction: atrial fibrillation is the most common sustained cardiac arrythmia in clinical practice. It is associated tosignificant morbimortality. The prevention of embolic episodes is a pillar of atrial fibrillation treatment and is basedmainly on anticoagulation. However, there is a significant proportion of patients with contraindications for anticoagula tion, to whom alternative treatments must be offered. Surgical exclusion of the left atrial appendage offers benefits inthis regard, and is associated to a lower rate of neurological events.Objective: primary endpoint: to evaluate the safety of the surgical exclusion of the left atrial appendage in patients withatrial fibrillation undergoing mitral valve surgery; secondary endpoint: to analyze the incidence of stroke in this population, and to analyze the survival rate in patients with and without left atrial appendage exclusion.Method: a single center, analytic, observational, retrospective study, comparing exclusion and no exclusion of the leftatrial appendage in patients with atrial fibrillation undergoing mitral valve surgery between January 2012 and December 2018. The variables were obtained from the institutional database. The follow up was telephonic and survival rateswere obtained from a national official database.Results: 69 patients were included (45 underwent surgical left atrial appendage exclusion). Statistically significant features between the groups were age (69.1±8.2 years without left atrial appendage exclusion; 63.6±10.3 years with leftatrial appendage exclusion, p=0.026), and the rate of surgical ablation of atrial fibrillation (29.2% without exclusion;68.9% with exclusion, p=0.002). The follow up was carried out in 33, finding no statistically significant differences between the groups. The survival rate of all patients was analyzed, finding no long term differences.Conclusion: according to the data analyzed, left atrial appendage exclusion is a safe procedure, and adds no furthercomplications to mitral valve surgery in patients with atrial fibrillation. It was not possible to prove that left atrial appendage exclusion significantly reduces the long term prevalence of ischemic stroke or modifies the survival rate.