European Society of Cardiology
European Society of Cardiology
Perspective from Timothy J. Gardner, MD
August 29, 2017
1 min read
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LAACS: LAA closure protects brain from ischemic events during open heart surgery

Perspective from Timothy J. Gardner, MD
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Jesper Park-Hansen

Patients who underwent left atrial appendage closure during open heart surgery had reduced the risk for long-term ischemic brain damage, according to the LAACS study presented at the European Society of Cardiology Congress.

“It seems as if surgical left atrial appendage closure on occasion to open heart surgery does protect the brain against ischemic events, and that was regardless of a previous atrial fibrillation diagnosis,” Jesper Park-Hansen, MD, a medical doctor in the department of cardiology at Bispebjerg/Frederiksberg University Hospital in Copenhagen, Denmark, said in the presentation.

Park-Hansen said during the presentation that AF occurs between 30% and 67% of the time in open heart surgery, and 1% to 3% of patients who have CABG experience a stroke within 1 year.

Researchers analyzed data from 187 patients who underwent CABG, valve surgery or both. Patients were randomly assigned to undergo closure of the LAA (n = 101) or not (n = 86).

The combined endpoint was stroke, transient ischemic attack or new silent cerebral infarction. Patients were followed up for up to 6 years. The secondary endpoint was stroke or TIA.

Of the intention-to-treat group, 141 patients underwent the assigned protocol.

In the intention-to-treat group, 14 patients assigned no closure and five patients assigned the closure procedure had ischemic cerebral events (P = .02). The per-protocol population had 14 ischemic cerebral events in those assigned no closure and four events in those assigned the closure procedure (P = .04).

The secondary endpoint occurred in eight patients assigned no closure and three patients assigned the closure procedure in the intention-to-treat group (P = .07). In the per-protocol group, eight patients assigned no closure and two patients assigned the closure procedure had events (P = .09).

Of the 14 events experienced by patients assigned the closure procedure, nine occurred 1 year after follow-up. The LAA closure procedure was not linked to any adverse events.

“This is the first study, and we’re eager to move on with a study on a larger scale. That is the next step for us,” Park-Hansen said. – by Darlene Dobkowski

Reference:

Park-Hansen J. Late Breaking Clinical Trials 3. Presented at: European Society of Cardiology Congress; August 26-30, 2017; Barcelona, Spain.

Disclosure: Park-Hansen reports that he has no relevant financial disclosures.