Our Summary
This research paper investigates the impact of a specific surgical procedure, left atrial appendage clip exclusion (LAACE), on the results of coronary artery bypass grafting (CABG), a common heart surgery, in patients with atrial fibrillation (an irregular, often rapid heart rate). The study looked at the medical records of over 4,000 people with atrial fibrillation who had received a CABG operation, some of whom also had the LAACE procedure.
The researchers found that the risk of thromboembolism, a condition where a blood clot forms and blocks a blood vessel, was 26% lower in patients who received both the CABG and LAACE procedures. They also found that these patients had a 45% lower risk of death in the long term (from 3 months to 2 years after the operation) compared to those who had only received the CABG operation. The study also found that the patients who received both procedures had fewer hospital readmissions and fewer total days in the hospital during the follow-up period.
However, the study did not find any differences in the risk of ischemic stroke (a type of stroke caused by a blockage in the blood supply to the brain) between the two groups. The overall costs of hospital treatment for the first year following the operation were also similar between the two groups.
In conclusion, the study suggests that LAACE can improve the results of CABG surgery in patients with atrial fibrillation, reducing the risk of blood clots and death, and leading to fewer hospital readmissions.
FAQs
- What is the impact of left atrial appendage clip exclusion (LAACE) on the results of coronary artery bypass grafting (CABG)?
- Did the study find any differences in the risk of ischemic stroke between patients who received only CABG versus those who received both CABG and LAACE?
- How does the LAACE procedure affect the overall costs of hospital treatment and readmissions following CABG surgery?
Doctor’s Tip
A helpful tip a doctor might give a patient about CABG is to discuss with your healthcare provider the option of also receiving a left atrial appendage clip exclusion (LAACE) procedure if you have atrial fibrillation. This additional procedure may help reduce the risk of blood clots and improve long-term outcomes after CABG surgery.
Suitable For
Patients who are typically recommended CABG are those with severe coronary artery disease, which is characterized by significant blockages in the arteries that supply blood to the heart muscle. These blockages can lead to chest pain (angina), shortness of breath, and in severe cases, heart attacks.
In addition, patients who have not responded well to other treatments for coronary artery disease, such as medication or lifestyle changes, may also be recommended for CABG. Patients with multiple blockages in the coronary arteries, or those with blockages in critical areas of the heart, may also benefit from CABG.
Furthermore, patients with certain risk factors for heart disease, such as diabetes, high blood pressure, or a family history of heart disease, may be recommended for CABG to reduce their risk of future heart problems. Patients with other heart conditions, such as atrial fibrillation, may also benefit from CABG, especially if they have significant blockages in their coronary arteries.
Overall, the decision to recommend CABG for a patient is based on a thorough evaluation of their individual medical history, risk factors, and the severity of their coronary artery disease. It is important for patients to discuss their treatment options with their healthcare provider to determine the best course of action for their specific situation.
Timeline
Before CABG:
- Patient undergoes diagnostic tests such as angiography to assess the severity of coronary artery disease.
- Patient may undergo lifestyle changes, medication management, and other treatments to manage symptoms and improve heart health.
- Patient may be referred to cardiac rehabilitation to improve physical fitness and overall health before surgery.
During CABG:
- Patient undergoes pre-operative preparation, including fasting and medication adjustments.
- Patient is administered general anesthesia and the surgeon performs the CABG procedure, which involves taking a healthy blood vessel from another part of the body and using it to bypass blocked or narrowed coronary arteries.
- Patient is monitored closely in the intensive care unit (ICU) immediately after surgery for any complications or signs of infection.
After CABG:
- Patient is transferred to a regular hospital room for further recovery and monitoring.
- Patient may experience pain, fatigue, and difficulty breathing in the days following surgery.
- Patient undergoes physical therapy and rehabilitation to regain strength and mobility.
- Patient is discharged from the hospital and continues to follow-up with their healthcare team for monitoring and management of heart health.
- Patient may need to make lifestyle changes, such as diet and exercise, to prevent future heart problems.
What to Ask Your Doctor
Here are some questions a patient should ask their doctor about CABG:
- Is CABG the best treatment option for my specific heart condition?
- What are the potential risks and complications associated with CABG surgery?
- How long is the recovery period after CABG surgery?
- Will I need to make any lifestyle changes after the surgery?
- Are there any alternative treatments to CABG that I should consider?
- How often will I need to follow up with you after the surgery?
- What is your experience and success rate with performing CABG surgeries?
- Will I need any additional procedures, such as LAACE, in conjunction with the CABG surgery?
- How will my atrial fibrillation be managed after the CABG surgery?
- What are the long-term outcomes and prognosis for patients who undergo CABG surgery with or without additional procedures like LAACE?
Reference
Authors: Soltesz EG, Dewan KC, Anderson LH, Ferguson MA, Gillinov AM. Journal: J Card Surg. 2021 Apr;36(4):1201-1208. doi: 10.1111/jocs.15335. Epub 2021 Jan 24. PMID: 33491275