Author(s)

Alexander P. Kossar¹, Yaagnik D. Kosuri¹, Samantha Nemeth², Brigitte E. Kazzi¹, Yuming Ning², James Doolittle¹, Denise McLaughlin¹, Paul Kurlansky², Isaac George^1*

¹Division of Cardiothoracic Surgery, New-York Presbyterian Hospital/Columbia University Irving Medical Center, New York, USA.
²Columbia HeartSource, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, USA.

Objectives: Left atrial appendage ligation (LAAL) may constitute alternative stroke prophylaxis in patients with atrial fibrillation (AF). Herein we describe the 30-day post discharge outcomes of cardiac surgery patients with elevated stroke risk with or without anticoagulation (AC) following epicardial LAAL. Methods: Data were reviewed for 479 consecutive adult patients who underwent epicardial LAAL from 2014-2019 (median CHA₂DS₂-VASc score = 4.0). There were 251 and 228 patients discharged with and without AC, respectively, who were followed for 30 days. Patients were matched via 1:1 Propensity Score Matching (PSM; n = 115 per group). Post-discharge outcomes included stroke, bleeding, readmission for cardiac re-intervention, mortality, and a composite endpoint comprised of the aforementioned outcomes. Results: There was no difference in post-discharge stroke incidence regardless of AC (adjusted cumulative incidence (ACI) 0.009 CI [0.001 - 0.043] with AC vs 0.009 CI [0.001 - 0.43] without AC; p = 0.826), post-discharge bleeding (ACI 0.018 CI [0.003 - 0.057] with AC vs 0.009 CI [0.001 - 0.046] without AC; p = 0.738), readmission for cardiac re-intervention (ACI 0.009 CI [0.009 - 0.009] with AC vs 0 CI [NA] without AC; p = 0.340, post-discharge mortality (ACI 0 CI NA with AC vs 0.009 CI [0.001 - 0.046] without AC; p = 0.123, or in the composite outcome (ACI 0.026 CI [0.007 - 0.069] with AC vs 0.027 CI [0.007 - 0.071] without AC; p = 0.824. Conclusion: Cessation of AC in patients with elevated stroke risk following epicardial LAAL during cardiac surgery does not affect stroke rate, mortality, or bleeding incidence up to 30 days post-discharge in this preliminary analysis.

Arrhythmias, Minimally Invasive Surgery, Perioperative Care

Kossar, A. , Kosuri, Y. , Nemeth, S. , Kazzi, B. , Ning, Y. , Doolittle, J. , McLaughlin, D. , Kurlansky, P. and George, I. (2023) Is Anticoagulation Warranted after Left Atrial Appendage Ligation in Patients at Risk for Stroke after Cardiac Surgery?. World Journal of Cardiovascular Surgery, 13, 26-43. doi: 10.4236/wjcs.2023.132003.