背景：我们试图评估左心耳治疗的不同手术方法，以确定是否有任何方法可以降低房颤相关的长期缺血性脑血管意外的发生率。
方法：共1243例患者接受左心耳摘除治疗，107例(8.6%)患者失访并排除.主要结局是缺血性脑血管事件的长期发生率（即，缺血性卒中,不包括短暂性脑缺血发作）和全因死亡率。
结果：在1136名患者中，37例（3.3%）发生缺血性脑血管事件。1年,5年,左心耳心外结扎组长期缺血性脑血管事件的10年自由度为99.7%,94.0%,90.8%,分别。1年,5年,左心耳心内缝合组的10年生存率为99.7%，94.6%,和93.6％，分别。左心耳心外结扎组与左心耳切除组比较差异有统计学意义(P=.041)。左心耳心外结扎组17例(4.6%)有长期缺血性脑血管事件(每年1.1%),左心耳心内缝合组14例患者（3.5%）（每年0.9%），左心耳切除组6例(1.7%)(每年0.44%)。与左心耳心外结扎术相比，左心耳切除术可以减少长期血栓性卒中的发生（95％置信区间，1.09-9.26；P=.035）。
结论：对于房颤患者，摘除左心耳可有效预防心房颤动引起的中风。
BACKGROUND: We sought to assess different surgical methods for left atrial appendage treatment to determine whether any could reduce the incidence of atrial fibrillation-related long-term ischemic cerebrovascular accidents.
METHODS: A total of 1243 patients were treated with left atrial appendage removal, and 107 patients (8.6%) were lost to follow-up and excluded. The primary outcome was the long-term incidence of ischemic cerebrovascular events (ie, ischemic stroke, excluding transient ischemic attack) and all-cause mortality.
RESULTS: Of the 1136 patients, 37 (3.3%) had ischemic cerebrovascular events. The 1-year, 5-year, and 10-year freedoms from long-term ischemic cerebrovascular events of the left atrial appendage extracardiac ligation group were 99.7%, 94.0%, and 90.8%, respectively. The 1-year, 5-year, and 10-year survivals of the left atrial appendage intracardiac suture group were 99.7%, 94.6%, and 93.6%, respectively. There was a significant difference between the left atrial appendage extracardiac ligation group and the left atrial appendage excision group (P = .041). Seventeen patients (4.6%) had long-term ischemic cerebrovascular events in the left atrial appendage extracardiac ligation group (1.1% per year), 14 patients (3.5%) in the left atrial appendage intracardiac suture group (0.9% per year), and 6 patients (1.7%) in the left atrial appendage excision group (0.44% per year). Left atrial appendage excision can reduce the occurrence of long-term thrombotic stroke compared with left atrial appendage extracardiac ligation (95% confidence interval, 1.09-9.26; P = .035).
CONCLUSIONS: For patients with atrial fibrillation, the removal of the left atrial appendage can effectively prevent stroke caused by atrial fibrillation.
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