Korean Circ J.  2023 Aug;53(8):566-577. 10.4070/kcj.2023.0038.

Is It Safe to Preserve Left Atrial Appendage During Maze Procedure?

• Song K
• Jang WS
• Park N
• Kim YS
• Kim JB

• KMID: 2545154
• DOI: http://doi.org/10.4070/kcj.2023.0038

Abstract

Background and Objectives
The left atrial appendage (LAA) can contribute significantly to LA mechanical contraction. Nevertheless, the preventive effect of LAA occlusion during the maze procedure against cerebral infarction remains controversial. In this study, we compared the surgical, cardiac hemodynamic, and neurologic outcomes between LAA preservation and occlusion performed during the maze procedure.
Methods
Between January 2015 and August 2021, 252 patients underwent the maze procedure using cryoablation at our medical center. After excluding patients according to our exclusion criteria (i.e., mechanical prosthesis implantation, preexisting LAA thrombus), LAA was preserved in 113 patients (non-occlusion group) and occluded in 75 patients (occlusion group). Outcomes were compared using propensity score matching (PSM).
Results
PSM did not reveal significant intergroup differences in baseline characteristics between the non-occlusion (n=53) and occlusion (n=53) groups. During a median follow-up of 44 months, 2 patients in the non-occlusion group (3.8%) experienced ischemic strokes. There was no significant difference in the rate of freedom from stroke (p=0.19) and major adverse cardiac events (p=0.43) between the 2 groups. Through echocardiography at 1-year follow-up, a statistically significant difference in LA mechanical contraction was observed between the non-occlusion group and occlusion group (24 of 33 [72.7%] vs. 18 of 37 [48.6%], respectively; p=0.04).
Conclusions
In this study, preservation of the LAA during the maze procedure resulted in better LA function than LAA occlusion, with similar rates of stroke.

Keyword

Atrial fibrillation; Maze procedure; Stroke

Figure

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  Figure 1 The ratio of patients with normal sinus rhythm after maze procedure of propensity-matched patients.

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  Figure 2 The results of MACEs during follow-up period after maze procedure.MACE = major adverse cardiovascular event; PSM = propensity score matching.

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  Figure 3 The result of freedom from cardiac death ratio after the maze procedure in both groups.PSM = propensity score matching.

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  Figure 4 Ratio of patients who have effective left atrial mechanical contraction in patient with normal sinus rhythm (in propensity-matched patients).LA = left atrial; TTE = transthoracic echocardiography.

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