Analysis of postoperative strokes in patients after resection or suturing of the left atrial appendage
Authors: Volkov D , Gorbunov D , Anohina A , Shulga E , Rygalov D , Gulniashkina K , Buyankov D , Sakovich V 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In 30%, the cause of strokes is AF. 90% of cases, thromboembolism occurs in the cerebral arteries, condemning the patient not only to disability, but also to death.
Considering that the formation of blood clots occurs in hemodynamically inactive areas of the LA, which is the apendege of the LA, it is advisable to combine surgical treatment of AF with its exclusion from systemic blood flow.

Purpose
Analyze the frequency of strokes in the follow up period in patients who have undergone surgical treatment of AF in combination with LAA resection.

Materials and Methods
364 patients were divided into 3 groups depending on the volume of operative treatment and the rhythm of the controlling strategy, 105 dropped out of the study due to the lack of data collection capability.
• Group I included 80 patients who underwent surgical AF treatment with LAA resection combined with valvular pathology correction or myocardial revascularization. Lethal outcome in this group was recorded in 6 (7.5%) patients caused by non-cardiac pathology. Surgical treatment of AF was performed by MAZE IV and left side MAZE.
• Group II - 140 people who performed valve pathology correction, without surgical treatment of AF and without LAA resection.
• Group III included 39 patients with a persistent form of AF who performed only LAA resection in combination with correction with another cardiac pathology. Group II and III mortality were 23 patients.
All patients in group I and III underwent LAA resection to exclude a possible source of blood clots. The stump was sutured with a continuous two-row suture on the base up to 2 mm from the LA wall.
After 36 months, patients from group I underwent echocardiography, electrocardiography, Holter monitoring, and a cardiologist examination. Group II and III analyses were performed by patient telemetry.

Results
• Long-term three-year results showed complete 100% freedom from acute cerebral circulation disorder in group I, where surgical treatment of AF was performed in combination with LAA resection;
• In group I with a persistent form of AF without LAA resection - acute cerebral circulation disorder occurred in 36 patients, which was 28.8%;
• In group III with permanent fibrillation with LAA resection, of the 31 patients, thromboembolic complication occurred in 4 patients (12.9%).
It is worth noting that after surgery in the distant period, patients of group I increased the average value of the ejection fraction by 4%, decreased volumes of the LA, and the functional class on NYHA changed from III to II, I.

Conclusion
The study performed the highest degree of absence of stroke in group I in early and follow up period. First of all, this is due to a comprehensive approach to the treatment of cardiac pathology, the preservation of sinus rhythm and LAA resection. Which, in addition to absence of stroke, leads to an improvement in the quality of life and a decrease in the functional class of heart failure.