无心房颤动患者心脏手术中左心耳封堵的临床结局：系统评价与荟萃分析。
完整摘要 · 中文译文
背景：左心耳是心脏血栓的主要来源，心脏手术中预防性封闭左心耳可能降低血栓栓塞风险。然而，其在术前无心房颤动（AF）患者中的获益仍不确定。 方法：我们检索了 PubMed、Web of Science、EMBASE 和 Cochrane Library，以查找在窦性心律接受心脏手术的患者中比较手术左心耳封堵（LAAO）与未行 LAAO 的随机对照试验和观察性研究。主要结局为新发短暂性脑缺血发作（TIA）/卒中、术后 AF 和全因死亡。二分类结局以比值比合并，连续结局以均数差合并，均带有 95% CIs。 结果：纳入 11 项研究，涉及 12 145 名参与者。与未行 LAAO 相比，手术 LAAO 降低了新发 TIA/卒中（比值比，0.75 [95% CI，0.62-0.90]）和出血（比值比，0.78 [95% CI，0.60-1.00]），但增加了术后 AF（比值比，1.27 [95% CI，1.06-1.53]）。2 组在全因死亡、30 天死亡和住院时间方面未检测到显著差异。亚组分析显示，不同研究设计、手术类型和 LAAO 技术间的效应估计存在一定差异。 结论：在接受心脏手术的窦性心律患者中，手术 LAAO 与新发 TIA/卒中及出血风险较低相关，但术后 AF 发生率较高，且全因死亡、30 天死亡或住院时间无显著差异。研究设计、心脏的类型 手术，和LAAO技术可能影响这些关联。鉴于证据确定性低至中等，这些发现应谨慎解读。
完整摘要 · 英文原文
BACKGROUND: The left atrial appendage is the primary source of cardiac thrombi, and prophylactic exclusion during cardiac surgery may reduce thromboembolic risk. However, its benefit in patients without preoperative atrial fibrillation (AF) remains uncertain. METHODS: We searched PubMed, Web of Science, EMBASE, and the Cochrane Library for randomized controlled trials and observational studies comparing surgical left atrial appendage occlusion (LAAO) versus no LAAO in patients with sinus rhythm undergoing cardiac surgery. Primary outcomes were new-onset transient ischemic attack (TIA)/stroke, postoperative AF, and all-cause death. Dichotomous outcomes were pooled as odds ratios and continuous outcomes as mean differences, with 95% CIs. RESULTS: Eleven studies involving 12 145 participants were included. Compared with no LAAO, surgical LAAO reduced new-onset TIA/stroke (odds ratio, 0.75 [95% CI, 0.62-0.90]) and bleeding (odds ratio, 0.78 [95% CI, 0.60-1.00]) but increased postoperative AF (odds ratio, 1.27 [95% CI, 1.06-1.53]). No significant differences were detected between the 2 groups in all-cause death, 30-day death, and length of stay. Subgroup analyses showed some variation in effect estimates across study design, type of surgery, and LAAO technique. CONCLUSIONS: In patients with sinus rhythm undergoing cardiac surgery, surgical LAAO was associated with a lower risk of new-onset TIA/stroke and bleeding but a higher incidence of postoperative AF, with no significant differences in all-cause death, 30-day death, or length of hospital stay. Study design, type of cardiac surgery, and LAAO technique may influence these associations. These findings should be interpreted cautiously given low to moderate certainty of evidence.