Document Detail


Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke.
MedLine Citation:
PMID:  16086933     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: This pilot study assessed the safety and efficacy of left atrial appendage (LAA) occlusion, performed at the time of coronary artery bypass grafting (CABG). METHODS AND RESULTS: At the time of CABG, 77 patients with risk factors for stroke were randomized to LAA occlusion or control. The LAA was occluded using sutures or a stapling device. Completeness of occlusion was assessed with transesophageal echocardiography. There were no significant differences in cardiopulmonary bypass duration, perioperative heart failure, atrial fibrillation, or bleeding between the 2 groups. During surgery, there were 9 appendage tears, all of which were repaired easily with sutures. Among patients having a postoperative transesophageal echocardiography, complete occlusion of the LAA was achieved in 45% (5/11) of cases using sutures and in 72% (24/33) using a stapler, P = .14. The rate of LAA occlusion by individual surgeons increased from 43% (9/21) to 87% (20/23) after performing 4 cases (P = .0001). After a mean follow-up of 13 +/- 7 months, 2.6% of patients had thromboembolic events. CONCLUSIONS: LAA occlusion at the time of CABG is safe. The rate of complete occlusion improves, to acceptable levels, with increased experience and the use of a stapling device. A large trial is needed to determine if LAA occlusion prevents stroke.
Authors:
Jeff S Healey; Eugene Crystal; Andre Lamy; Kevin Teoh; Lloyd Semelhago; Stefan H Hohnloser; Irene Cybulsky; Labib Abouzahr; Corey Sawchuck; Sandra Carroll; Carlos Morillo; Peter Kleine; Victor Chu; Eva Lonn; Stuart J Connolly
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  150     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-09     Completed Date:  2005-12-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  288-93     Citation Subset:  AIM; IM    
Affiliation:
McMaster University, Hamilton, Ontario, Canada. healeyj@hhsc.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Appendage / surgery*,  ultrasonography
Atrial Fibrillation / complications
Brain Ischemia / epidemiology
Coronary Artery Bypass / methods*
Coronary Disease / complications,  surgery
Echocardiography, Transesophageal
Female
Heart Failure / epidemiology
Humans
Hypertension / complications
Intracranial Embolism / etiology,  prevention & control*
Intraoperative Complications / epidemiology
Ligation
Male
Pilot Projects
Postoperative Complications / epidemiology,  prevention & control*
Postoperative Hemorrhage / epidemiology
Risk Factors
Surgical Stapling
Suture Techniques
Treatment Outcome
Comments/Corrections
Comment In:
Am Heart J. 2006 Jun;151(6):e1; author reply e3   [PMID:  16781207 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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