Preventing Stroke in Heart Disease Patients with Simple Surgery-Safe and Cheap

Richard Whitlock, a professor of surgery at McMaster University who performs cardiac surgery. Credits: Hamilton Health Sciences

Removing the left atrial appendage reduces the risk of stroke in patients with atrial fibrillation by more than one-third.

According to a large international study led by McMaster University, simple surgery can save patients with arrhythmias from often fatal strokes.

Researchers have found that removing the left atrial appendage, an unused finger-like tissue that can trap blood in the heart chambers and increase the risk of blood clots, reduces the risk of stroke in patients with atrial fibrillation by three minutes. We have found that it decreases by more than one.

Even better, the reduced risk of coagulation comes in addition to the other benefits that patients with this condition usually get from prescribed anticoagulants.

“If you have atrial fibrillation and have heart surgery, the left atrial appendage is set to form a blood clot, so the surgeon should remove the left atrial appendage. Our study shows that this is safe for stroke prevention. And it has been shown to be effective, “said Richard Whitlock, the first author of the study.

“This will have a positive impact on tens of thousands of patients worldwide.”

Left atrial appendage, intact. Credit: Heather Borsellino

Whitlock is a scientist at the Population Health Research Institute (PHRI), a joint laboratory of McMaster University and Hamilton Health Sciences (HHS). He is a professor of surgery at McMaster University, chair of the Canadian Research Committee for Cardiovascular Surgery, a cardiac surgeon at HHS, and is supported by the Heart and Stroke Foundation’s Career Awards.

The co-principal investigator of this study is Stuart Connolly, who has advanced the field by establishing the efficacy and safety of new anticoagulants. He is an emeritus professor at McMaster University, a senior scientist at PHRI, and a cardiologist at HHS.

Left atrial appendage after obstruction. Credit: Heather Borsellino

“The results of this study will soon change practice because this procedure is simple, fast, and safe for 15% of cardiac surgery patients with atrial fibrillation, which can prevent significant stroke pain.” Said Connolly.

The research results are New England Journal of Medicine And today, it was announced at a conference of the American College of Cardiology.

The study followed 4,811 people in 27 countries who suffered from atrial fibrillation and were taking anticoagulants. Consent patients undergoing cardiopulmonary bypass surgery were randomly selected for additional left cardio-ear obstruction surgery. Their results compared to those who just took the drug. They were all followed for a median of 4 years.

Stuart Connolly. Credit: Population Health Research Institute

Whitlock has been suspected of having a blood clot in the left atrial appendage of a patient with atrial fibrillation since the 1940s, a structure that is useless if the heart is exposed for other surgery. Said it made sense to disconnect. This is now proven to be true.

Atrial fibrillation is common in the elderly and is responsible for about 25 percent of ischemic strokes caused when blood clots block the arteries that supply parts of the brain. The average age of patients in this study was 71 years.

“In the past we had only medicine. Now we can treat atrial fibrillation with both medicine and surgery to ensure much better results,” Whitlock said. Stated.

He said the current study tested the procedure during heart surgery, which is being done for other reasons, but the procedure can also be done in a less invasive way for patients who have not undergone heart surgery. It was. He added that future research to consider that approach would be important.

According to Whitlock, the left atrial appendage is a remnant of the way the human heart is formed as an embryo and has little function in later years.

“This is a safe, safe and inexpensive procedure with no long-term adverse effects, and the impact is long-term.”

Reference: May 15, 2021 New England Journal of Medicine..

External funding for this study was provided by the Canadian Institute of Health and the Heart and Stroke Foundation of Canada.