Preventive effect on postoperative atrial fibrillation and stroke by ablation of the ligament of Marshall and amputation of the left atrial appendage

2023 Fiscal Year Final Research Report

• Project/Area Number: 19K17615
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 53020:Cardiology-related
• Research Institution: Juntendo University
• Principal Investigator: Endo Daisuke 順天堂大学, 医学部, 助教 (50815644)
• Project Period (FY): 2019-04-01 – 2024-03-31
• Keywords: 心房細動 / 左心耳 / Marshall靭帯 / 冠動脈バイパス術

Outline of Final Research Achievements

This study investigated the effectiveness of Marshall ligament resection for postoperative atrial fibrillation (AF) in patients with preoperative sinus rhythm, as well as the efficacy of left atrial appendage (LAA) closure in dialysis patients. Among 323 patients who underwent coronary artery bypass grafting (CABG), the incidence of postoperative AF was compared between the Marshall ligament resection group (28 patients) and the non-resection group (295 patients), with no significant difference observed. Out of 2,783 patients who underwent CABG, 242 were dialysis patients with sinus rhythm. Clinical outcomes were compared based on the presence or absence of LAA closure. It was demonstrated that LAA closure reduced the risk of mortality and stroke in dialysis patients with sinus rhythm.

Free Research Field

心臓血管外科学

Academic Significance and Societal Importance of the Research Achievements

冠動脈バイパス術（CABG）後に生じる心房細動（AF）は最も頻度の高い合併症の一つである。AFは左心耳（LAA）に血栓を形成することで、脳梗塞の原因となりうる。特に、透析を受けている末期腎不全（ESRD-HD）患者は、AFに関連した脳卒中リスクが高い。塞栓症予防として抗凝固療法は標準治療であるが、ESRD-HD患者は出血リスクが高いことから抗凝固療法のベネフィットとリスクは議論が分かれる。本研究において、術前洞調律のESRD-HD患者において、CABGと同時LAA閉鎖が全死亡ならびに脳卒中リスク軽減効果があることを示したことは意義が高い。