The Impact Of Left Atrial Appendage Occlusion On Stroke Prevention In Atrial Fibrillation Patient With Mitral Valve Replacement

Objective :to evaluate the prophylactic effect of closed left atrial appendage during mitral valve replacement on cardiogenic stroke.Methods: A total of 286 patients with preoperative atrial fibrillation undergoing mitral valve replacement between January 2016 and June 2021,53.14±10.48 years of age,and 170 women(58.6%)were selected.We compared the incidence and risk factors for ischemic stroke during hospitalization between the left atrial appendage-occlusion group(168 patients)and patent atrial appendage-occlusion group(118 patients)according to whether patients underwent left atrial appendage closure at the same time.Risk factors for postoperative stroke were analyzed using logistic multivariate regression.Results: Left atrial appendage closure was associated with a higher proportion of women with hypertension,cardiac dysfunction,and left atrial thrombosis and a higher proportion of patients with simultaneous tricuspid and mechanical valve closure.There was no difference in postoperative time of mechanical ventilation,hospital stay and 24 h drainage.There was no significant difference in postoperative rate of secondary open thoracotomy and in-hospital mortality.There were 19 patients with stroke during the postoperative hospital stay(6.5%);the rate of stroke was lower in the left atrial appendage closure group than in the left atrial appendage patent group(2.0% vs.4.4%,P<0.001).Logistic regression analysis revealed that ICU stay h(OR=1.013,95%CI:1.009 to 1.017,P=.000),postoperative left atrial diameter(OR=1.398,95%CI:1.227 to 1.592,P=.000),and postoperative aortic sinus area(OR=2.002,95%C/:1.581 to 2.536,P=.000)were risk factors for postoperative stroke,whereas left atrial appendage closure(OR=0.299,95%C/:0.110 to0.812,P=0.018)was a protective factor for preventing stroke.Conclusion: Patients with atrial fibrillation have a high risk of stroke early after mitral valve replacement.Postoperative aortic sinus and left atrial diameter are predictors of risk of stroke during hospitalization,while intraoperative left atrial appendage closure is a protective factor against stroke.