This study evaluated the nationwide associations between concomitant left atrial appendage clip (LAAC) placement during cardiac surgery and postoperative outcomes. We identified 1,260,999 patients who underwent coronary artery bypass grafting, valve, and aortic surgeries in the 2016 to 2020 Nationwide Readmissions Database and stratified by concomitant LAAC versus no LAAC placement. Patients who underwent surgical ablation were excluded. Mortality and complications were compared during index admissions and for patients readmitted within 30 and 90 days of the index discharge date for unmatched and propensity score–matched groups. Overall, 6.7% (84,293) of patients underwent cardiac surgery and concomitant LAAC placement without surgical ablation. After propensity score matching, the index admission mortality and overall complications were not different in patients with LAAC versus patients without LAAC. LAAC placement was associated with increased any-cause 30-day readmissions (15% vs 13%, p <0.01). In patients with LAAC, within 30 days, there were no differences in mortality (3.9% vs 3.8%, p = 0.60) or overall complications (64% vs 63%, p = 0.20), whereas stroke was lower (5.3% vs 6.5%, p <0.01) and heart failure was higher (35% vs 30%, p <0.01). For patients readmitted within 90 days, similar findings were observed for any-cause readmissions, mortality, overall complications, stroke, and heart failure. In conclusion, concomitant LAAC placement during cardiac surgery was associated with lower early postdischarge incidence of stroke and a favorable overall risk-benefit profile. Given these short-term findings in a real-world population of all patients who underwent cardiac surgery, longer-term studies with more granular data are needed to evaluate the potential benefit of this practice.

中文翻译：

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心脏手术期间左心耳夹放置后的结果：全国分析

本研究评估了全国范围内心脏手术期间同时放置左心耳夹 (LAAC) 与术后结果之间的关联。我们在 2016 年至 2020 年全国再入院数据库中确定了 1,260,999 名接受冠状动脉旁路移植术、瓣膜和主动脉手术的患者，并按同时进行 LAAC 与不进行 LAAC 放置进行分层。接受手术消融的患者被排除在外。对未匹配组和倾向评分匹配组的指数入院期间以及指数出院日期 30 和 90 天内重新入院的患者的死亡率和并发症进行了比较。总体而言，6.7% (84,293) 的患者接受了心脏手术并同时进行 LAAC 放置，但未进行手术消融。倾向评分匹配后，接受 LAAC 的患者与未接受 LAAC 的患者的入院死亡率和总体并发症指数没有差异。 LAAC 放置与任何原因的 30 天再入院率增加相关（15% vs 13%，p <0.01）。在 LAAC 患者中，30 天内，死亡率（3.9% vs 3.8%，p = 0.60）或总体并发症（64% vs 63%，p = 0.20）没有差异，而卒中发生率较低（5.3% vs 6.5） %，p <0.01），心力衰竭较高（35% vs 30%，p <0.01）。对于 90 天内重新入院的患者，在任何原因的再入院、死亡率、总体并发症、中风和心力衰竭方面观察到类似的结果。总之，心脏手术期间同时放置 LAAC 与较低的出院后早期卒中发生率和良好的总体风险效益相关。鉴于在所有接受心脏手术的现实世界人群中的这些短期研究结果，需要使用更详细的数据进行长期研究来评估这种做法的潜在益处。