Outcomes After Left Atrial Appendage Clip Placement During Cardiac Surgery: A Nationwide Analysis

This study evaluated 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 2016-2020 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 (PSM) groups. Overall, 6.7% (84,293) of patients underwent cardiac surgery and concomitant LAAC placement without surgical ablation. After PSM, index admission mortality and overall complications were not different in LAAC versus no-LAAC patients. LAAC placement was associated with increased any-cause 30-day readmissions (15% versus 13%; P<.01). Among LAAC patients readmitted within 30 days, there were no differences in mortality (3.9% versus 3.8%; P=.60) or overall complications (64% versus 63%; P=.20), while stroke was lower (5.3% versus 6.5%; P<.01) and heart failure was higher (35% versus 30%; P<.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 post-discharge incidence of stroke and a favorable overall risk-benefit profile. Given these short-term findings in a real-world population of all cardiac surgery patients, longer-term studies with more granular data are needed to evaluate the potential benefit of this practice.