Does Left Atrial Appendage Occlusion in LVAD Patients Impact Outcomes: A Single Centre Study

Purpose Results of left atrial appendage occlusion (LAAO) in coronary artery bypass and valvular surgeries from large multicentre studies remain contradictory. No data has been presented on the outcomes of LAAO during left ventricular assist device (LVAD) implant. Therefore, we studied the effects of LAAO during LVAD implantation on postoperative risk of stroke and mortality. Methods This is a single-centre retrospective cohort study including consecutive patients who underwent LVAD implantation between October/2004 and April/2018. We performed a univariate Cox regression analysis to assess the effect of LAAO on the risk of post-operative stroke and mortality. Results Among 156 patients who underwent LVAD implantation (mean age, 52.5 [SD 12.8] years, 34 [21.8%] females), 14 (9.0%) underwent concurrent LAAO. As seen in table one, there were no significant differences in baseline characteristics except for gender (p=0.039). There were no significant differences in intraoperative identification of thrombus, stroke, or embolism between groups. Patients who received LAAO had longer bypass time (p=0.035), ICU stay (p=0.006), and days hospitalized (p=0.019) compared to those without LAAO. Median follow-up was 7 months [range 0 - 92]. A total of 23 strokes and 48 deaths were identified in our cohort and LAAO was not associated with a reduced risk of stroke (HR 1.014 [0.233 - 4.419]; p=0.985) or mortality (HR 1.209 [0.432 - 3.384]; p=0.718). Conclusion Among patients undergoing LVAD implantation, concurrent surgical LAAO was independently associated with an increase in bypass time and ICU and hospital length of stay. Furthermore, LAAO was not associated with a reduced risk of subsequent stroke and all-cause mortality. Further research including data from large registries is required to definitively determine the role of surgical LAAO during LVAD implantation.