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Open Access 01-12-2018 | Research article

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

Authors: 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

Published in: Journal of Cardiothoracic Surgery | Issue 1/2018

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.

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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
Authors: 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
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2018
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-018-0740-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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