Randomized Trial of Surgical Left Atrial Appendage Closure: Protection Against Cerebrovascular Events

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Standard

Randomized Trial of Surgical Left Atrial Appendage Closure : Protection Against Cerebrovascular Events. / Madsen, Christoffer V.; Park-Hansen, Jesper; Holme, Susanne J.V.; Irmukhamedov, Akhmadjon; Carranza, Christian L.; Greve, Anders M.; Al-Farra, Gina; Riis, Robert G.C.; Nilsson, Brian; Clausen, Johan S.R.; Nørskov, Anne S.; Kruuse, Christina; Truelsen, Thomas C.; Dominguez, Helena.

I: Seminars in Thoracic and Cardiovascular Surgery, Bind 35, Nr. 4, 2023, s. 664-672.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt

Harvard

Madsen, CV, Park-Hansen, J, Holme, SJV, Irmukhamedov, A, Carranza, CL, Greve, AM, Al-Farra, G, Riis, RGC, Nilsson, B, Clausen, JSR, Nørskov, AS, Kruuse, C, Truelsen, TC & Dominguez, H 2023, 'Randomized Trial of Surgical Left Atrial Appendage Closure: Protection Against Cerebrovascular Events', Seminars in Thoracic and Cardiovascular Surgery, bind 35, nr. 4, s. 664-672. https://doi.org/10.1053/j.semtcvs.2022.06.012

APA

Madsen, C. V., Park-Hansen, J., Holme, S. J. V., Irmukhamedov, A., Carranza, C. L., Greve, A. M., Al-Farra, G., Riis, R. G. C., Nilsson, B., Clausen, J. S. R., Nørskov, A. S., Kruuse, C., Truelsen, T. C., & Dominguez, H. (2023). Randomized Trial of Surgical Left Atrial Appendage Closure: Protection Against Cerebrovascular Events. Seminars in Thoracic and Cardiovascular Surgery, 35(4), 664-672. https://doi.org/10.1053/j.semtcvs.2022.06.012

Vancouver

Madsen CV, Park-Hansen J, Holme SJV, Irmukhamedov A, Carranza CL, Greve AM o.a. Randomized Trial of Surgical Left Atrial Appendage Closure: Protection Against Cerebrovascular Events. Seminars in Thoracic and Cardiovascular Surgery. 2023;35(4):664-672. https://doi.org/10.1053/j.semtcvs.2022.06.012

Author

Madsen, Christoffer V. ; Park-Hansen, Jesper ; Holme, Susanne J.V. ; Irmukhamedov, Akhmadjon ; Carranza, Christian L. ; Greve, Anders M. ; Al-Farra, Gina ; Riis, Robert G.C. ; Nilsson, Brian ; Clausen, Johan S.R. ; Nørskov, Anne S. ; Kruuse, Christina ; Truelsen, Thomas C. ; Dominguez, Helena. / Randomized Trial of Surgical Left Atrial Appendage Closure : Protection Against Cerebrovascular Events. I: Seminars in Thoracic and Cardiovascular Surgery. 2023 ; Bind 35, Nr. 4. s. 664-672.

Bibtex

@article{915f70e64da74e4082e74f40bdb33dfb,
title = "Randomized Trial of Surgical Left Atrial Appendage Closure: Protection Against Cerebrovascular Events",
abstract = "Following open-heart surgery, atrial fibrillation and stroke occur frequently. Left atrial appendage closure added to elective open-heart surgery could reduce the risk of ischemic stroke. We aim to examine if routine closure of the left atrial appendage in patients undergoing open-heart surgery provides long-term protection against cerebrovascular events independently of atrial fibrillation history, stroke risk, and oral anticoagulation use. Long-term follow-up of patients enrolled in the prospective, randomized, open-label, blinded evaluation trial entitled left atrial appendage closure by surgery (NCT02378116). Patients were stratified by oral anticoagulation status and randomized (1:1) to left atrial appendage closure in addition to elective open-heart surgery vs standard care. The primary composite endpoint was ischemic stroke events, transient ischemic attacks, and imaging findings of silent cerebral ischemic lesions. Two neurologists blinded for treatment assignment adjudicated cerebrovascular events. In total, 186 patients (82% males) were reviewed. At baseline, mean (standard deviation (SD)) age was 68 (9) years and 13.4% (n = 25/186) had been diagnosed with atrial fibrillation. Median [interquartile range (IQR)] CHA2DS2-VASc was 3 [2,4] and 25.9% (n = 48/186) were receiving oral anticoagulants. Mean follow-up was 6.2 (2.5) years. The left atrial appendage closure group experienced fewer cerebrovascular events; intention-to-treat 11 vs 19 (P = 0.033, n = 186) and per-protocol 9 vs 17 (P = 0.186, n = 141). Left atrial appendage closure as an add-on open-heart surgery, regardless of pre-surgery atrial fibrillation and oral anticoagulation status, seems safe and may reduce cerebrovascular events in long-term follow-up. More extensive randomized clinical trials investigating left atrial appendage closure in patients without atrial fibrillation and high stroke risk are warranted.",
keywords = "Atrial fibrillation, Cardiac surgery, Exclusion, Occlusion, Open-heart surgery, Stroke, Transient ischemic attack",
author = "Madsen, {Christoffer V.} and Jesper Park-Hansen and Holme, {Susanne J.V.} and Akhmadjon Irmukhamedov and Carranza, {Christian L.} and Greve, {Anders M.} and Gina Al-Farra and Riis, {Robert G.C.} and Brian Nilsson and Clausen, {Johan S.R.} and N{\o}rskov, {Anne S.} and Christina Kruuse and Truelsen, {Thomas C.} and Helena Dominguez",
note = "Publisher Copyright: {\textcopyright} 2022 The Author(s)",
year = "2023",
doi = "10.1053/j.semtcvs.2022.06.012",
language = "English",
volume = "35",
pages = "664--672",
journal = "Seminars in Thoracic and Cardiovascular Surgery",
issn = "1043-0679",
publisher = "W.B. Saunders Ltd",
number = "4",

}

RIS

TY - JOUR

T1 - Randomized Trial of Surgical Left Atrial Appendage Closure

T2 - Protection Against Cerebrovascular Events

AU - Madsen, Christoffer V.

AU - Park-Hansen, Jesper

AU - Holme, Susanne J.V.

AU - Irmukhamedov, Akhmadjon

AU - Carranza, Christian L.

AU - Greve, Anders M.

AU - Al-Farra, Gina

AU - Riis, Robert G.C.

AU - Nilsson, Brian

AU - Clausen, Johan S.R.

AU - Nørskov, Anne S.

AU - Kruuse, Christina

AU - Truelsen, Thomas C.

AU - Dominguez, Helena

N1 - Publisher Copyright: © 2022 The Author(s)

PY - 2023

Y1 - 2023

N2 - Following open-heart surgery, atrial fibrillation and stroke occur frequently. Left atrial appendage closure added to elective open-heart surgery could reduce the risk of ischemic stroke. We aim to examine if routine closure of the left atrial appendage in patients undergoing open-heart surgery provides long-term protection against cerebrovascular events independently of atrial fibrillation history, stroke risk, and oral anticoagulation use. Long-term follow-up of patients enrolled in the prospective, randomized, open-label, blinded evaluation trial entitled left atrial appendage closure by surgery (NCT02378116). Patients were stratified by oral anticoagulation status and randomized (1:1) to left atrial appendage closure in addition to elective open-heart surgery vs standard care. The primary composite endpoint was ischemic stroke events, transient ischemic attacks, and imaging findings of silent cerebral ischemic lesions. Two neurologists blinded for treatment assignment adjudicated cerebrovascular events. In total, 186 patients (82% males) were reviewed. At baseline, mean (standard deviation (SD)) age was 68 (9) years and 13.4% (n = 25/186) had been diagnosed with atrial fibrillation. Median [interquartile range (IQR)] CHA2DS2-VASc was 3 [2,4] and 25.9% (n = 48/186) were receiving oral anticoagulants. Mean follow-up was 6.2 (2.5) years. The left atrial appendage closure group experienced fewer cerebrovascular events; intention-to-treat 11 vs 19 (P = 0.033, n = 186) and per-protocol 9 vs 17 (P = 0.186, n = 141). Left atrial appendage closure as an add-on open-heart surgery, regardless of pre-surgery atrial fibrillation and oral anticoagulation status, seems safe and may reduce cerebrovascular events in long-term follow-up. More extensive randomized clinical trials investigating left atrial appendage closure in patients without atrial fibrillation and high stroke risk are warranted.

AB - Following open-heart surgery, atrial fibrillation and stroke occur frequently. Left atrial appendage closure added to elective open-heart surgery could reduce the risk of ischemic stroke. We aim to examine if routine closure of the left atrial appendage in patients undergoing open-heart surgery provides long-term protection against cerebrovascular events independently of atrial fibrillation history, stroke risk, and oral anticoagulation use. Long-term follow-up of patients enrolled in the prospective, randomized, open-label, blinded evaluation trial entitled left atrial appendage closure by surgery (NCT02378116). Patients were stratified by oral anticoagulation status and randomized (1:1) to left atrial appendage closure in addition to elective open-heart surgery vs standard care. The primary composite endpoint was ischemic stroke events, transient ischemic attacks, and imaging findings of silent cerebral ischemic lesions. Two neurologists blinded for treatment assignment adjudicated cerebrovascular events. In total, 186 patients (82% males) were reviewed. At baseline, mean (standard deviation (SD)) age was 68 (9) years and 13.4% (n = 25/186) had been diagnosed with atrial fibrillation. Median [interquartile range (IQR)] CHA2DS2-VASc was 3 [2,4] and 25.9% (n = 48/186) were receiving oral anticoagulants. Mean follow-up was 6.2 (2.5) years. The left atrial appendage closure group experienced fewer cerebrovascular events; intention-to-treat 11 vs 19 (P = 0.033, n = 186) and per-protocol 9 vs 17 (P = 0.186, n = 141). Left atrial appendage closure as an add-on open-heart surgery, regardless of pre-surgery atrial fibrillation and oral anticoagulation status, seems safe and may reduce cerebrovascular events in long-term follow-up. More extensive randomized clinical trials investigating left atrial appendage closure in patients without atrial fibrillation and high stroke risk are warranted.

KW - Atrial fibrillation

KW - Cardiac surgery

KW - Exclusion

KW - Occlusion

KW - Open-heart surgery

KW - Stroke

KW - Transient ischemic attack

U2 - 10.1053/j.semtcvs.2022.06.012

DO - 10.1053/j.semtcvs.2022.06.012

M3 - Journal article

C2 - 35777693

AN - SCOPUS:85135189100

VL - 35

SP - 664

EP - 672

JO - Seminars in Thoracic and Cardiovascular Surgery

JF - Seminars in Thoracic and Cardiovascular Surgery

SN - 1043-0679

IS - 4

ER -

ID: 323970972