| Background: Left atrial appendage(LAA) obliteration is a proven stroke preventive measure for patients with nonvalvular atrial fibrillation(AF). However, the efficacy of LAA obliteration for patients with AF after bioprosthetic mitral valve replacement(MVR) remains unclear.Purpose: This study aims to estimate the efficacy of LAA obliteration to prevent embolism and investigate the predictors of thromboembolism post-bioprosthetic MVR.Methods: We retrospectively studied 173 AF subjects with bioprosthetic MVR; among which, 81 cases underwent LAA obliteration using an endocardial running suture method. The main outcome measure was the occurrence of thrombosis events(TEs). The mean follow-up time was 40 ± 17 months.Results: 136 patients were with AF rhythm postoperatively. The incidence rate of TEs was 13.97% for postoperative AF subjects, a dilated left atrium(> 49.5 mm) was identified as an independent risk factor of TEs(OR 10.619, 95% CI 2.754- 40.94, P = 0.001). For postoperative AF patients with or without LAA, the incidence rate of TEs was 15.8%(9/57) and 12.7%(10/79)(p = 0.603), and it was 2.7%(1/36) and 4.2%(2/48) for subgroup subjects with LA < 49.5 mm, 38.1%(8/21) and 25.8%(8/31) for those with LA > 49.5 mm(p = 0.346).Conclusion: LAA obliteration surgically in patients with valvular AF undergoing bioprosthetic MVR did not reduce TEs, even when the CHA2DS2-VASc score was ≥ 2 points.Background: Concomitant mitral valve repair surgery and radiofrequency ablation of atrial fibrillation(AF) is now widely used in atrial fibrillation patients with mitral valve disease, but there are still some patients with AF postoperatively, whether the left atrial appendage(LAA) closure is effective to prevent the incidence of postoperative ischemic stroke for patients with recurrent AF is unclear.Objective: To observe the postoperative sinus rhythm restoration and stroke incidence for AF patients with mitral valve repair, as well as the effect of LAA closure on prevention of postoperative ischemic stroke; and explore effective ways to prevent postoperative ischemic stroke for those patients with recurrent AF.Methods: A retrospective study of 147 AF patients with mitral valve disease, all patients were treated with valvuloplasty, of which 121 patients underwent concomitant radiofrequency ablation of AF. Echocardiographic parameters, postoperatively sinus rhythm(SR) restoration and incidence of stroke were recorded. Both the univariate and multivariate methods were applied to analyze the risk factors of postoperative recurrent AF and stroke.Results: The mean follow-up time was 54.85 ± 24.52 months. There were 84 cases(57.14%) with postoperative SR, and 63 cases(43.86%) with recurrent AF. A total of 5 cases suffered ischemic stroke postoperatively, among which 4 cases with recurrent AF(3 cases with LAA closure, and one without LAA closure, 3/32, 9.3% vs. 1/31,3.2%; p = 0.613), only one with SR(4/63, 6.35% vs.1/84, 1.19%; p = 0.164); Concomitant radiofrequency ablation of AF helped the recovery of sinus rhythm(OR0.323,95%CI 0.108 – 0.974,p = 0.045). Preoperative duration of AF and postoperative left atrial size were important factors in maintaining postoperative sinus rhythm(OR0.915,95%CI 0.877 – 0.955,p < 0.001;OR1.106,95%CI 1.003- 1.115,p = 0.04).Conclusion: Concomitant mitral valvuloplasty and AF ablation surgery were the key to prevent postoperative ischemic stroke, the LAA closure surgically did not reduce the incidence of postoperative stroke simply.Background: Patients with atrial fibrillation(AF) conventionally take warfarin to prevent stroke. However, inappropriate anticoagulation can lead to serious complications. Reducing the incidence of thromboembolic events in these patients has become the subject of recent focus.Purpose: To investigate the effect of left atrial appendage(LAA) obliteration and radiofrequency ablation(RFA) of AF on the occurrence of postoperative stroke and relative risk factors in patients with valvular AF.Methods: Seven hundred and two patients(mean age 52.57 ± 9.24 years) with valvular AF undergoing mitral valve replacement were investigated, about 284 subjects with LAA obliteration, 363 subjects undergoing AF ablation. Characteristics of patients such as left ventricular end-diastolic diameter(LVEDD) were recorded; anticoagulation levels, heart rhythm, and stroke were followed up for 43 ± 17 months.Results:Approximately 34%(239/702) of patients with preoperative atrial fibrillation recovered to sinus rhythm; the ratio was 11.5%(39/339) in patients without ablation and 55.1%(200/363) in patients with ablation. A total of 20 cases suffered ischemic stroke postoperatively, 5 cases with LAA closure, 15 cases without LAA closure(5/284, 1.76% vs. 15/418, 3.53%, p = 0.173), 5 cases with sinus rhythm and 15 cases with AF(5/239,2.13% vs. 15/463,3.24%,p = 0.449). Multivariate analysis showed that LAA closure may have the protective effect on prevention of ischemic stroke for patients with mechanical mitral valve replacement(OR0.481, 95%CI0.173-1.340,p = 0.162), and enlarged left ventricular end diastolic diameter was a risk factor for postoperative stroke(OR 3.214, 95%CI 1.216- 8.479,p = 0.019).Conclusion: LAA obliteration tended to have a protective effect on the occurrence of stroke. But RFA to restore SR didn’t show an obvious protective effect. LVEDD > 55 mm was found to be related to the occurrence of postoperative stroke in studied patients. |
