Left atrial appendage exclusion with less invasive left ventricular assist device implantation
© 2022 Wiley Periodicals LLC..
OBJECTIVES: The objective of this single-center, pilot, prospective, and historical control study is to evaluate safety and feasibility outcomes associated with left atrial appendage exclusion (LAAE) concomitant with left ventricular assist device (LVAD) implantation via less invasive surgery (LIS) as a stroke prevention strategy.
METHODS: A predefined number of 30 eligible subjects scheduled for LIS LVAD with LAAE were enrolled in the prospective arm between January 2020 and February 2021. Eligible retrospective LIS LVAD patients without LAAE were propensity-matched in a 1:1 ratio with the prospective arm subjects. The primary study objectives were to evaluate the safety, feasibility, and efficacy of the LAAE concomitant with LIS LVAD.
RESULTS: Preoperative characteristics of patients in the Non-LAAE and LAAE groups were similar. LAAE was successfully excluded in all prospective patients (100%). Primary safety endpoints of chest tube output within the first 24 postoperative hours, Reoperation for bleeding within 48 h, and index hospitalization mortality demonstrated comparable safety of LAAE versus Non-LAAE with LIS LVAD. Cox proportional hazard regression demonstrated that LAAE with LIS LVAD was associated with 37% and 49% reduction in the risk of stroke and disabling stroke, respectively (p > .05).
CONCLUSION: Results from our pilot study demonstrated the safety and feasibility of LAAE concomitant with LIS LVAD as a stroke prevention strategy. This is the first prospective study describing LAAE performed concomitantly to less invasive LVAD implantation. The efficacy of LAAE in long-term stroke prevention needs to be confirmed in future prospective randomized clinical trials.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
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| Enthalten in: |
Journal of cardiac surgery - 37(2022), 12 vom: 02. Dez., Seite 4967-4974 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bjelic, Milica [VerfasserIn] |
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| Links: |
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| Themen: |
Atrial appendage |
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| Anmerkungen: |
Date Completed 05.01.2023 Date Revised 11.01.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/jocs.17200 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM348922647 |
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| 245 | 1 | 0 | |a Left atrial appendage exclusion with less invasive left ventricular assist device implantation |
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| 500 | |a Date Revised 11.01.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 Wiley Periodicals LLC. | ||
| 520 | |a OBJECTIVES: The objective of this single-center, pilot, prospective, and historical control study is to evaluate safety and feasibility outcomes associated with left atrial appendage exclusion (LAAE) concomitant with left ventricular assist device (LVAD) implantation via less invasive surgery (LIS) as a stroke prevention strategy | ||
| 520 | |a METHODS: A predefined number of 30 eligible subjects scheduled for LIS LVAD with LAAE were enrolled in the prospective arm between January 2020 and February 2021. Eligible retrospective LIS LVAD patients without LAAE were propensity-matched in a 1:1 ratio with the prospective arm subjects. The primary study objectives were to evaluate the safety, feasibility, and efficacy of the LAAE concomitant with LIS LVAD | ||
| 520 | |a RESULTS: Preoperative characteristics of patients in the Non-LAAE and LAAE groups were similar. LAAE was successfully excluded in all prospective patients (100%). Primary safety endpoints of chest tube output within the first 24 postoperative hours, Reoperation for bleeding within 48 h, and index hospitalization mortality demonstrated comparable safety of LAAE versus Non-LAAE with LIS LVAD. Cox proportional hazard regression demonstrated that LAAE with LIS LVAD was associated with 37% and 49% reduction in the risk of stroke and disabling stroke, respectively (p > .05) | ||
| 520 | |a CONCLUSION: Results from our pilot study demonstrated the safety and feasibility of LAAE concomitant with LIS LVAD as a stroke prevention strategy. This is the first prospective study describing LAAE performed concomitantly to less invasive LVAD implantation. The efficacy of LAAE in long-term stroke prevention needs to be confirmed in future prospective randomized clinical trials | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a LAAO | |
| 650 | 4 | |a LIS | |
| 650 | 4 | |a LVAD | |
| 650 | 4 | |a atrial appendage | |
| 650 | 4 | |a minimal invasive | |
| 650 | 4 | |a stroke | |
| 700 | 1 | |a Wood, Katherine L |e verfasserin |4 aut | |
| 700 | 1 | |a Simon, Bartholomew V |e verfasserin |4 aut | |
| 700 | 1 | |a Vidula, Himabindu |e verfasserin |4 aut | |
| 700 | 1 | |a Cheyne, Christina |e verfasserin |4 aut | |
| 700 | 1 | |a Chase, Karin |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Isaac Y |e verfasserin |4 aut | |
| 700 | 1 | |a Alexis, Jeffrey D |e verfasserin |4 aut | |
| 700 | 1 | |a McNitt, Scott |e verfasserin |4 aut | |
| 700 | 1 | |a Goldenberg, Ilan |e verfasserin |4 aut | |
| 700 | 1 | |a Gosev, Igor |e verfasserin |4 aut | |
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