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Review
. 2022 Apr;45(4):567-570.
doi: 10.1111/pace.14471. Epub 2022 Mar 2.

Surgical left atrial appendage occlusion in patients with left ventricular assist device

Jakrin Kewcharoen  1 , Kuldeep Shah  2 , Rahul Bhardwaj  1 , Tahmeed Contractor  1 , Mohit K Turagam  3 , Ravi Mandapati  1 , Dhanunjaya Lakkireddy  4 , Jalaj Garg  1
Affiliations
Review

Surgical left atrial appendage occlusion in patients with left ventricular assist device

Jakrin Kewcharoen et al. Pacing Clin Electrophysiol. 2022 Apr.

Abstract

Background: Thromboembolic (TE) events are among the most common and devastating adverse events in patients with continuous-flow left ventricular assist device (cf-LVAD). Given the high burden of AF among cf-LVAD patients, we sought to evaluate the effect of concomitant surgical LAAO in patients receiving cf-LVAD.

Methods: A systematic search using electronic databases was performed using the keywords: "left atrial appendage occlusion" and "left ventricular assist device." Statistical analysis was performed using metapackage for R version 4.0 and Rstudio version 1.2. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data between two groups. The primary outcomes included: (a) stroke; (b) LVAD pump thrombosis; (c) all-cause mortality RESULTS: Three studies with a total of 305 patients (LAAO = 68 and No-LAAO = 237) were included in the analysis. HeartMate II (39%) and Heartware (27.5%) were the two most common cf-LVADs utilized, while only 5% received HeartMate III. At a mean follow up of 1.47 years, LAAO group had a lower risk of stroke (8.8% vs. 15.2%, RR 0.64; 95% CI 0.28-1.49), LVAD pump thrombosis (1.5% vs. 3.8%, RR 0.28; 95% CI 0.05-1.55) and all-cause mortality (5.9% vs. 20.2%, RR 0.69; 95% CI 0.19-2.52) when compared with no-LAAO group, but the difference did not reach statistical significance.

Conclusion: Concomitant surgical LAAO at the time of cf-LVAD implantation demonstrated a trend toward positive outcomes and was not associated with adverse outcomes during the follow-up period, though the results were not statistically significant.

Keywords: LVAD; heartmate; left atrial appendage occlusion; pump thrombosis; stroke.

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References

REFERENCES

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