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Radakovic D, Penov K, Lazarus M, Madrahimov N, Hamouda K, Schimmer C, Leyh RG, Bening C. The completeness of the left atrial appendage amputation during routine cardiac surgery. BMC Cardiovasc Disord 2023; 23:308. [PMID: 37340354 DOI: 10.1186/s12872-023-03330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Left atrial appendage (LAA) is the origin of most heart thrombi which can lead to stroke or other cerebrovascular event in patients with non-valvular atrial fibrillation (AF). This study aimed to prove safety and low complication rate of surgical LAA amputation using cut and sew technique with control of its effectiveness. METHODS 303 patients who have undergone selective LAA amputation were enrolled in the study in a period from 10/17 to 08/20. The LAA amputation was performed concomitant to routine cardiac surgery on cardiopulmonary bypass with cardiac arrest with or without previous history of AF. The operative and clinical data were evaluated. Extent of LAA amputation was examined intraoperatively by transoesophageal echocardiography (TEE). Six months in follow up, the patients were controlled regarding clinical status and episodes of strokes. RESULTS Average age of study population was 69.9 ± 19.2 and 81.9% of patients were male. In only three patients was residual stump after LAA amputation larger than 1 cm with average stump size 0.28 ± 0.34 cm. 3 patients (1%) developed postoperative bleeding. Postoperatively 77 (25.4%) patients developed postoperative AF (POAF), of which 29 (9.6%) still had AF at discharge. On 6 months follow up only 5 patients had NYHA class III and 1 NYHA class IV. Seven patients reported with leg oedema and no patient experienced any cerebrovascular event in early postoperative follow up. CONCLUSION LAA amputation can be performed safely and completely leaving minimal to no LAA residual stump.
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Affiliation(s)
- Dejan Radakovic
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
| | - Kiril Penov
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Marc Lazarus
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Nodir Madrahimov
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Khaled Hamouda
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Christoph Schimmer
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Rainer G Leyh
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Constanze Bening
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
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Impact of Left Atrial Appendage Closure Combined with Catheter Ablation on Endocrine and Mechanical Cardiac Function in Patients with Atrial Fibrillation. J Interv Cardiol 2022; 2022:3932912. [PMID: 35360092 PMCID: PMC8957483 DOI: 10.1155/2022/3932912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/02/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background The combined procedure of left atrial appendage closure (LAAC) and catheter ablation (CA) is a safe and feasible therapy to treat patients with atrial fibrillation (AF). However, the effect of the combined procedure on cardiac function remains unclear. This study aimed to investigate the changes in endocrine and mechanical function of the heart following the combined procedure. Methods This retrospective study included 62 consecutive patients who underwent the combined procedure of AF ablation and WATCHMAN LAAC and 62 sex and age-matched patients who only received AF ablation. During follow-up, patients were examined for brain natriuretic peptide (BNP) levels to represent endocrine cardiac function. Mechanical cardiac function was assessed during echocardiographic examination by means of the LA ejection fraction, LA strain (Ƹ), and LA strain rate (SR). Results (1) The BNP levels decreased acutely after the procedure, rose at day 3 postoperation, but trended downwards at 3 months postoperation in both groups. No significant difference was observed between the two groups. (2) LA ejection fraction, LA Ƹ, and SR exhibited a continuous upward trend over a 3-month follow-up in both groups. There was no significant difference in LA ejection fractions, SRe (the parameter of LA conduit function), and SRa (the parameter of LA booster pump function) between the two groups. However, the Ƹ and SRs (the parameters of LA reservoir function) improved in patients treated with CA alone. Conclusions The combined procedure of LAAC and CA significantly improved the endocrine and mechanical function of the heart. Compared to simple CA, based on CA with LAAC intervention, it does not significantly change LA endocrine function but may lead to a decline in the LA reservoir function.
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Herman D, Osmancik P, Neuzil P, Hala P, Lekesova V, Benesova K, Hozman M, Jarkovsky J, Novackova M, Widimsky P, Reddy VY. The effect of left atrial appendage closure on heart failure biomarkers: A PRAGUE-17 trial subanalysis. J Cardiovasc Electrophysiol 2021; 32:2645-2654. [PMID: 34402135 DOI: 10.1111/jce.15206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The randomized PRAGUE-17 trial demonstrated noninferiority of left atrial appendage closure (LAAC) to non-vitamin K anticoagulants (NOACs) for the prevention of major cardiovascular or cerebrovascular events. However, the left atrial appendage is an important source of natriuretic peptides and plays a role in left atrial reservoir function. Changes of heart failure (HF) biomarkers after LAAC compared to NOAC has not been studied. The aim of the study was to compare the changes in concentrations of HF biomarkers between LAAC and NOAC patients. METHODS Of 402 patients randomized in the PRAGUE-17 trial, biomarkers were analyzed in 144 patients (73 in the NOAC and 71 in the LAAC group). Both groups had similar baseline characteristics. Serum concentration of NT-proBNP, NT-proANP, Galectin-3, and GDF-15 were measured at baseline (before the procedure in the LAAC group), at the 6-month (and at 24-month for NT-proBNP) follow-up timepoint. RESULTS There were no significant differences in baseline, 6 month, and delta (δ = baseline - 6 month) concentrations of NT-proANP between the groups (NOAC: baseline 2.6 [0.5; 4.9], 6-month 3.1 [1.8; 4.8], p = .068; LAAC: baseline 3.3 [1.1; 4.6], 6-month 2.6 [0.9; 5.3], p = .51; p value for δ in concentrations between groups = 0.42). Similarly, there were no significant differences in baseline, 6, 24 months, and delta concentrations of NT-proBNP between the groups (NOAC: baseline 461.0 [113.5; 1342.0], 6 month 440.0 [120.5; 1291.5], 24 month 798 [274; 2236], p = .39; LAAC: baseline 421.0 [100.0; 1320.0], 6 month 601.0 [145.0; 1230.0], 24 month 855 [410; 1367], p = .28; p value for δ in concentrations between groups = 0.73 at 6 months, and 0.58 at 24 months). Finally, no significant differences were present in baseline, 6 month, and δ concentrations of Galectin-3 and GDF-15 between the two groups. CONCLUSION LAAC did not significantly influence the levels of HF biomarkers 6 months after the procedure.
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Affiliation(s)
- Dalibor Herman
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University Prague, Prague, Czech Republic
| | - Pavel Osmancik
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University Prague, Prague, Czech Republic
| | - Petr Neuzil
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Hala
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Veronika Lekesova
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Klara Benesova
- Department of Data Analysis, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Marek Hozman
- Cardiocenter, Karlovy Vary Regional Hospital, Karlovy Vary, Czech Republic
| | - Jiri Jarkovsky
- Department of Data Analysis, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Martina Novackova
- Department of Data Analysis, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Petr Widimsky
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University Prague, Prague, Czech Republic
| | - Vivek Y Reddy
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic.,Department of Electrophysiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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