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- Title
Surgical left atrial appendage occlusion in patients with left ventricular assist device.
- Authors
Kewcharoen, Jakrin; Shah, Kuldeep; Bhardwaj, Rahul; Contractor, Tahmeed; Turagam, Mohit K.; Mandapati, Ravi; Lakkireddy, Dhanunjaya; Garg, Jalaj
- Abstract
Background: Thromboembolic (TE) events are among the most common and devastating adverse events in patients with continuous‐flow left ventricular assist device (cf‐LVAD). Given the high burden of AF among cf‐LVAD patients, we sought to evaluate the effect of concomitant surgical LAAO in patients receiving cf‐LVAD. Methods: A systematic search using electronic databases was performed using the keywords: "left atrial appendage occlusion" and "left ventricular assist device." Statistical analysis was performed using metapackage for R version 4.0 and Rstudio version 1.2. Mantel–Haenszel risk ratio (RR) random‐effects model was used to summarize data between two groups. The primary outcomes included: (a) stroke; (b) LVAD pump thrombosis; (c) all‐cause mortality Results: Three studies with a total of 305 patients (LAAO = 68 and No‐LAAO = 237) were included in the analysis. HeartMate II (39%) and Heartware (27.5%) were the two most common cf‐LVADs utilized, while only 5% received HeartMate III. At a mean follow up of 1.47 years, LAAO group had a lower risk of stroke (8.8% vs. 15.2%, RR 0.64; 95% CI 0.28–1.49), LVAD pump thrombosis (1.5% vs. 3.8%, RR 0.28; 95% CI 0.05–1.55) and all‐cause mortality (5.9% vs. 20.2%, RR 0.69; 95% CI 0.19–2.52) when compared with no‐LAAO group, but the difference did not reach statistical significance. Conclusion: Concomitant surgical LAAO at the time of cf‐LVAD implantation demonstrated a trend toward positive outcomes and was not associated with adverse outcomes during the follow‐up period, though the results were not statistically significant
- Subjects
LEFT heart ventricle surgery; STROKE prevention; THROMBOSIS prevention; CAUSES of death; META-analysis; CONFIDENCE intervals; SYSTEMATIC reviews; ATRIAL fibrillation; HEART assist devices; SURGERY; PATIENTS; TREATMENT effectiveness; DESCRIPTIVE statistics; DEATH; DATA analysis software; ODDS ratio; DATA analysis; LEFT heart atrium; EVALUATION
- Publication
Pacing & Clinical Electrophysiology, 2022, Vol 45, Issue 4, p567
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.14471