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The left atrial appendage amputation during off-pump coronary artery bypass grafting prevents stroke
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  • Daisuke Endo,
  • Tohru Asai,
  • Taira Yamamoto,
  • Atsumi Oishi,
  • Yasutaka Yokoyama,
  • Akie Shimada,
  • Kan Kajimoto,
  • Satoshi Matsushita,
  • Shizuyuki Dohi,
  • Atsushi Amano
Daisuke Endo
Juntendo University
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Tohru Asai
Juntendo University
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Taira Yamamoto
Juntendo University Nerima Hospital
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Atsumi Oishi
Juntendo Shizuoka Hospital
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Yasutaka Yokoyama
Toda Chuo General Hospital
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Akie Shimada
Juntendo University Nerima Hospital
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Kan Kajimoto
Juntendo Shizuoka Hospital
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Satoshi Matsushita
Juntendo University
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Shizuyuki Dohi
Juntendo University
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Atsushi Amano
Juntendo University
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Abstract

Background: Postoperative atrial fibrillation (POAF) occurs in 20% to 50% of patients soon after cardiac surgery, and is associated with subsequent newly developed AF. Left atrial appendage closure is effective in preventing stroke among patients with nonvalvular AF. However, the prophylactic effect of left atrial appendage amputation (LAAA) in stroke prevention among patients with sinus rhythm has not been proven. Methods: We analyzed 977 consecutive patients undergoing off-pump coronary artery bypass grafting (OPCAB) with sinus rhythm, with or without concomitant LAAA, from 2011 to 2017 at our institution in a retrospective observational manner. A total of 550 patients (56.3%) underwent concomitant LAAA, any effect thereof in preventing early (<30 days) and later stroke was examined. Results: The incidences of POAF and early stroke were not significantly different between the groups. The incidence of later stroke was higher in patients without LAAA than in those with LAAA (4.0% vs. 1.6%; p = 0.02). In a subanalysis of patients without LAAA, stroke occurred more frequently in those with POAF than those without POAF (7.5% vs. 2.7%; p = 0.03), while in patients receiving LAAA, stroke incidences did not differ between those with and without POAF. Multivariate cox proportional hazard model showed POAF without LAAA was the only independent predictor of stroke (HR: 2.86; 95% CI: 1.10 to 7.45; p=0.03). Conclusions: Concomitant surgical LAA amputation during OPCAB reduces the risk of stroke.

Peer review status:IN REVISION

06 Jun 2021Submitted to Journal of Cardiac Surgery
07 Jun 2021Submission Checks Completed
07 Jun 2021Assigned to Editor
14 Jun 2021Reviewer(s) Assigned
20 Jul 2021Review(s) Completed, Editorial Evaluation Pending
20 Jul 2021Editorial Decision: Revise Major
08 Aug 20211st Revision Received
09 Aug 2021Submission Checks Completed
09 Aug 2021Assigned to Editor
10 Aug 2021Reviewer(s) Assigned
20 Aug 2021Review(s) Completed, Editorial Evaluation Pending
07 Sep 2021Editorial Decision: Revise Major