Left Atrial Appendage Ligation During Cardiac Surgery May Prevent Postoperative Atrial Fibrillation And Atrial Fibrillation-Related Cerebrovascular Accident

Objective:The aim of the study was to determine whether routine left atrial appendage ligation in cardiac surgery would reduce the risk of postoperative atrial fibrillation and postoperative atrial fibrillation-related cerebrovascular accident. Methods: We performed an institutional review board-approved, case-control, retrospective chart review of adult patients who underwent cardiac surgery by a single surgeon between January 1,2012, and June 30,2014. Preoperative data were collected, and outcomes through postoperative were analyzed.Results:A total of 486 patients were reviewed. Subjects with postoperative atrial fibrillation were 1.8times (95%confidence interval, 1.03-3.00) more likely to undergo valve surgery,3.6 times (95%confidence interval, 1.83-7.13) more likely to be aged more than 60 years, and 10.9 times (95% confidence interval,2.68-44.55) more likely to have undergone non left atrial appendage ligation. In the left atrial appendage ligation group with postoperative atrial fibrillation, there were 1 subjects (0.7%) with a postoperative cardiovascular accident. In the non-left atrial appendage ligation group with postoperative atrial fibrillation, there were 10 subjects (2.9%) with a postoperative cardiovascular accident (0.7% vs2.9%,p<0.001). Conclusions:Although postoperative atrial fibrillation remains a common complication of cardiac surgery, there was a significant decrease in the incidence of postoperative cerebrovascular accidents since routine ligation of the left atrial appendage was undertaken.