Document Detail


Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion?
MedLine Citation:
PMID:  19942634     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Should patients undergoing cardiac surgery with atrial fibrillation (AF) have left atrial appendage (LAA) exclusion?' Altogether 310 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that despite finding five clinical trials including one randomised controlled trial, that studied around 1400 patients who underwent LAA occlusion, the results of these studies do not clearly show a benefit for appendage occlusion. Indeed of the five studies, only one showed a statistical benefit for LAA occlusion, with three giving neutral results and in fact one demonstrating a significantly increased risk. One reason for this may be the inability to achieve acceptably high rates of successful occlusion on echocardiography when attempting to perform this procedure. The highest success rate was only 93% but most studies reported only a 55-66% successful occlusion rate when attempting closure in a variety of methods including stapling, ligation and amputation. Currently, the evidence is insufficient to support LAA occlusion and may indeed cause harm especially if incomplete exclusion occurs.
Authors:
Alan G Dawson; Sanjay Asopa; Joel Dunning
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-11-26
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  10     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-21     Completed Date:  2010-03-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  306-11     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK. alan.g.dawson.04@aberdeen.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Animals
Atrial Appendage / surgery*
Atrial Fibrillation / complications,  surgery*
Benchmarking
Cardiac Surgical Procedures* / adverse effects
Catheter Ablation
Evidence-Based Medicine
Female
Humans
Male
Middle Aged
Patient Selection
Risk Assessment
Thromboembolism / etiology,  prevention & control
Treatment Outcome
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2010 Feb;10(2):311   [PMID:  20089688 ]

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


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