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

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.