Use of left atrial appendage occlusion among older cardiac surgery patients with preoperative atrial fibrillation: a national cohort study.
Use of left atrial appendage occlusion among older cardiac surgery patients with preoperative atrial fibrillation: a national cohort study.
复制标题
在患有术前房颤的老年心脏手术患者中使用左心耳封堵术：一项全国队列研究。
DOI：
10.1007/s10840-019-00519-w
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
MatthewBrennan,J
中科院分区：
文献类型：
--
作者：
Friedman,DanielJ;Gaca,JeffreyG;Wang,Tongrong;Malaisrie,SChris;Holmes,DavidR;Piccini,JonathanP;Suri,RakeshM;Mack,MichaelJ;Badhwar,Vinay;Jacobs,JeffreyP;Peterson,EricD;Chow,Shein-Chung;MatthewBrennan,J
心房颤动（AF）患者接受心脏手术后发生卒中的风险显著增加。越来越多的证据表明，外科左心耳封堵术（S-LAAO）可能有可能大幅降低这种卒中风险;然而，S-LAAO仅用于少数接受心脏手术的AF患者。我们试图找出与使用S-LAAO相关的因素。（2011年7月-2012年6月）接受心脏手术的术前AF老年患者（n= 11，404）来自Medicare相关的胸外科医师学会成人心脏手术数据库，我们采用logistic和线性回归模型评估了与S-LAAO使用相关的患者和医院特征。（平均年龄，76岁; 39%女性），4177例（37%）接受了S-LAAO。25%（“未保护”患者）未使用S-LAAO或出院抗凝。随着CHA 2DS 2-VASc（充血性心力衰竭;高血压;年龄≥ 75岁;糖尿病;卒中、短暂性脑缺血发作或血栓栓塞;血管疾病;年龄65 - 74岁;性别类别（女性））评分的增加，S-LAAO的总体倾向显著降低（p趋势< 0.001）。有很大的变异性，在S-LAAO使用跨地理区域，和S-LAAO更常见的学术和高容量的瓣膜手术centers.ConclusionsSubstantial变异性在使用S-LAAO存在。在许多情况下，手术被推迟的病人可能是最受益的（即，CHA 2DS 2-VASc评分定义的卒中风险增加的患者）。
PurposePatients with atrial fibrillation (AF) undergoing cardiac surgery are at substantially increased risk for stroke. Increasing evidence has suggested that surgical left atrial appendage occlusion (S-LAAO) may have the potential to substantially mitigate this stroke risk; however, S-LAAO is performed in a minority of patients with AF undergoing cardiac surgery. We sought to identify factors associated with usage of S-LAAO.MethodsIn a nationally-representative, contemporary cohort (07/2011–06/2012) of older patients undergoing cardiac surgery with preoperative AF (n= 11,404) from the Medicare-linked Society of Thoracic Surgeons Adult Cardiac Surgery Database, we evaluated patient and hospital characteristics associated with S-LAAO use by employing logistic and linear regression models.ResultsIn this cohort (average age, 76 years; 39% female), 4177 (37%) underwent S-LAAO. Neither S-LAAO nor discharge anticoagulation was used in 25% (“unprotected” patients). The overall propensity for S-LAAO decreased significantly with increasing CHA2DS2-VASc (congestive heart failure; hypertension; age 75 years or older; diabetes mellitus; stroke, transient ischemic attack, or thromboembolism; vascular disease; age 65 to 74 years; sex category (female)) score (ptrend< 0.001). There was substantial variability in S-LAAO use across geographic regions, and S-LAAO was more commonly performed at academic and higher-volume valve surgery centers.ConclusionsSubstantial variability in use of S-LAAO exists. In many instances, the procedure is being deferred in the patients that may be poised to benefit the most (i.e., those with increased CHA2DS2-VASc score-defined stroke risk).