Prophylactic Left Atrial Appendage Exclusion in Cardiac Surgery Patients With Elevated CHA2DS2-VASc Score: Results of the Randomized ATLAS Trial

• DOI: 10.1177/15569845221123796
• Publication Date: 2022-11-14T06:43:48Z
• Authors: Marc W. Gerdisch; H. Edward Garrett; Mubashir A. Mumtaz; John F. Grehan; Mario Castillo-Sang; Jeffrey S. Miller; George L. Zorn; Stanley A. Gall; John A. Johnkoski; Basel Ramlawi
• Keywords: Stroke

Objective: Patients with elevated CHA 2 DS -VASc scores are at high risk for atrial fibrillation (AF) and thromboembolic events (TE) after cardiac surgery. Left appendage exclusion (LAAE) is a permanent, continuous approach to stroke prevention in AF, overcoming limitations of oral anticoagulation (OAC). We report ATLAS trial results focused on LAAE technical success perioperative safety TE rates without surgery patients who developed postoperative AF (POAF). Methods: (NCT02701062) was prospective, multicenter, feasibility trial. age ≥18 years, undergoing structural heart procedure, no preoperative ≥2, HAS-BLED ≥2 were randomized 2:1 or LAAE. POAF and/or received followed 1 year. evaluated intraoperative transesophageal echocardiography. Results: A total 562 ( n = 376) 186). Mean (3.4 vs 3.4) (2.8 2.9) similar groups. (no flow nor residual stump >10 mm) 99%. One LAAE-related serious adverse event (0.27%) occurred resolved sequelae. There 44.3% POAF. Through year, 3.4% 5.6% had TE. OAC used by 32.5% patients. Bleeding higher than (16.1% 5.4%, P 0.008). Conclusions: demonstrated rate successful low Study should be considered future design further evaluate prophylactic risk.