AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO) during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all elig...AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO) during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation(AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n = 40107) met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke(OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of allcause mortality, AF, and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.展开更多
OBJECTIVES: The purpose of this study was to examine the two-year clinical ou tcomes in patients enrolled in the Sirolimus-Eluting Stent in De Novo Native Co ronary Lesions(SIRIUS) study. BACKGROUND: The SIRIUS study ...OBJECTIVES: The purpose of this study was to examine the two-year clinical ou tcomes in patients enrolled in the Sirolimus-Eluting Stent in De Novo Native Co ronary Lesions(SIRIUS) study. BACKGROUND: The SIRIUS study was a double-blinded randomized study which demonstrated that sirolimus-eluting stents(SES) signifi cantly improved angiographic results(at 8 months) and clinical outcomes(at 9 and 12 months) compared with bare-metal stents(BMS). METHODS: Patients with de nov o native coronary artery lesions randomized to either SES(533 patients) or contr ol BMS(525 patients) were followed for two years. RESULTS: Between one and two y ears, there were infrequent additional clinical events that were equally distrib uted between the sirolimus and control groups. After two years, target lesion re vascularization was 5.8%and 21.3%in SES and control patients, respectively(p< 0.001), and major adverse cardiovascular events and target vessel failure rates were 10.1%versus 24.4%and 12.0%versus 26.7%, respectively(p< 0.0001 for both ). There were no differences in death, myocardial infarction, and stent thrombosis between the two groups. CONCLUSIONS: Clinical outcomes two years af ter implantation of SES continue to demonstrate significant reduction in the nee d for repeat target lesion(and vessel) revascularization compared with BMS witho ut evidence for either disproportionate late restenosis or late stent thrombosis .展开更多
基金Supported by no external funding.Dr.Benditt is supported in part by a grant from the Dr.Earl E Bakken family in support of heart-brain research
文摘AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO) during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation(AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n = 40107) met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke(OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of allcause mortality, AF, and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.
文摘OBJECTIVES: The purpose of this study was to examine the two-year clinical ou tcomes in patients enrolled in the Sirolimus-Eluting Stent in De Novo Native Co ronary Lesions(SIRIUS) study. BACKGROUND: The SIRIUS study was a double-blinded randomized study which demonstrated that sirolimus-eluting stents(SES) signifi cantly improved angiographic results(at 8 months) and clinical outcomes(at 9 and 12 months) compared with bare-metal stents(BMS). METHODS: Patients with de nov o native coronary artery lesions randomized to either SES(533 patients) or contr ol BMS(525 patients) were followed for two years. RESULTS: Between one and two y ears, there were infrequent additional clinical events that were equally distrib uted between the sirolimus and control groups. After two years, target lesion re vascularization was 5.8%and 21.3%in SES and control patients, respectively(p< 0.001), and major adverse cardiovascular events and target vessel failure rates were 10.1%versus 24.4%and 12.0%versus 26.7%, respectively(p< 0.0001 for both ). There were no differences in death, myocardial infarction, and stent thrombosis between the two groups. CONCLUSIONS: Clinical outcomes two years af ter implantation of SES continue to demonstrate significant reduction in the nee d for repeat target lesion(and vessel) revascularization compared with BMS witho ut evidence for either disproportionate late restenosis or late stent thrombosis .
