92. Surgical Left Atrial Appendage Exclusion During Open Cardiac Surgery in Patients without Atrial Fibrillation Provides 4 Year Ischemic Stroke and Mortality Benefit

Objective: The impact of a surgical left atrial appendage exclusion (LAAE) device on ischemic stroke in non-atrial fibrillation (AF) patients undergoing open cardiac procedures is unknown. The current retrospective study assessed LAAE in non-AF patients during open cardiac surgery and long-term ischemic stroke and all-cause mortality.

Methods: Real World Data Insights, a US national all payers' claims database which covers approximately 80% of the insured population was utilized. Non-AF patients (>65 years) who underwent coronary artery bypass (CAB) or valve procedures with or without concomitant sur-gical epicardial LAAE between 2015-2020 with a minimum of 2-year follow-up were included. Inverse probability treatment weighting (IPTW) was employed to balance confounders between groups, and logistic regression was utilized for comparisons.

Results: After IPTW adjustment there were no differences in patient demographics, oral anticoagulant (OAC) use, age (74.4 vs. 75.3 years) and CHA₂DS₂-VASc score (4.8 vs. 4.8 points). Patients treated with isolated open CAB represented 48.8% in both arms of the study (n=29,953.6) and those with any type of open valve with/without CAB procedure represented 51.3% of patients (n=31,465.3). Post operative atrial tachyarrhythmia (AT) was higher for LAAE (13.6%, n=144.0 vs. 6.8%, n=4,106.0; P<0.001), and remained higher through 4-year (29.3%, n=310.0, vs. 23.7%, n=14,316.0; p<0.001). Any OAC use in the first year after surgery was greater for LAAE (24.8%, n=186.0, vs. 17.0%, n=7,459.0; p<0.001), which persisted into follow-up. The primary outcome, ischemic stroke had lower event rates and odds ratios (OR) for LAAE at 30 days (4.3%, n=45.7, vs. 5.9%, n=3,556.2, OR 0.75, confidence interval (CI) 0.53 – 0.98, p=0.03), 31 days to 4 years (7.7%, n=81.2, vs. 10.1%, n=6,093.9, OR 0.76, CI 0.58 – 0.93, p=0.008), and index through 4 years (12.0%, n=126.9, vs. 16.0%, n=9,660.2, OR 0.75, CI 0.54 – 0.95, p=0.02) (Table 1). Secondary outcomes event rates and OR were lower through 4 years for LAAE, including ischemic stroke and systemic embolism (p=0.03), thromboembolism (p=0.007), major bleed (p=0.01), and all-cause mortality (p<0.001) (Table1).

Conclusion: LAAE during open cardiac surgery in non-AF patients was associated with a reduction in ischemic stroke and all-cause mortality. Additional information from randomized trials is required to confirm these findings, as well as the interaction between OAC and surgical LA

Patrick McCarthy (1), Roxana Mehran (2), Marc Gerdisch (3), Basel Ramlawi (4), Randall Lee (5), Michael Ferguson (6), Yihang Liu (7), Miran Foster (8), Jane Kruse (9), Richard Whitlock (10), (1) Northwestern Memorial Hospital, Chicago, IL, (2) Mount Sinai Hospital, New York, NY, (3) Franciscan Health Heart Center, Indianapolis, IN, (4) Lankenau Heart Institute, Wynnewood, PA, (5) Moffitt Hospital, San Francisco, CA, (6) N/A, Minnetonka, MN, (7) STATinMED, LLC, Dallas, TX, (8) STATinMED, Dallas, TX, (9) Northwestern Medicine, Chicago, IL, (10) Population Health Research Institute, Hamilton, Canada

Kelley Hutcheson

Commentator

Patrick McCarthy

Abstract Presenter

Patrick M. McCarthy, M.D., is Vice President of Northwestern Medical Group, and Executive Director of the Bluhm Cardiovascular Institute (BCVI) which employs approximately 1600 physicians and staff at 11 Northwestern hospitals.  He trained at the Mayo Clinic and Stanford University and practiced at the Cleveland Clinic from 1990 until 2004 as Surgical Director of Heart Transplantation and the Kaufman Center for Heart Failure.  The Northwestern heart and heart surgery program rapidly ascended in the U.S. News & World Report rankings from unranked in 2004 to a top 10 U.S. program, and the highest ranked in Illinois and surrounding states.  Dr. McCarthy also has a joint appointment with the Department of Biomedical Engineering of Northwestern University, is a member of AOA, and has invented several medical products. Applying a philanthropic gift from Neil Bluhm, Dr. McCarthy founded the unique Center for Artificial Intelligence in Cardiovascular Disease in 2018 to advance the use of AI in CV disease and launch a Master of Science in AI degree granting program for CV trainees. His primary focus is on clinical integration of Northwestern Medicine programs across the health system.