Clinical Outcomes of Left Atrial Appendage Occlusion During Cardiac Surgery in Patients Without Atrial Fibrillation: A Systematic Review and Meta-Analysis.
Qingchun Song, Xiaokang Tu, Zilong Zheng et al.
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In 30 seconds
This systematic review and meta-analysis combined randomized and observational studies comparing surgical left atrial appendage occlusion (LAAO) with no occlusion during cardiac surgery in patients with sinus rhythm and no preoperative atrial fibrillation. Across 11 studies involving 12 145 participants, LAAO was associated with lower odds of new-onset TIA/stroke (odds ratio, 0.75 [95% CI, 0.62-0.90]) and higher odds of postoperative AF (odds ratio, 1.27 [95% CI, 1.06-1.53]). No significant differences were detected in mortality or length of stay; the authors note low to moderate certainty of evidence.
Key findings
- LAAO was associated with lower odds of new-onset TIA/stroke: odds ratio, 0.75 [95% CI, 0.62-0.90].
- Postoperative AF was more frequent with LAAO: odds ratio, 1.27 [95% CI, 1.06-1.53].
- Bleeding was lower with LAAO: odds ratio, 0.78 [95% CI, 0.60-1.00].
- No significant differences were detected in all-cause death, 30-day death, or length of stay.
Why it matters
The findings highlight a potential trade-off when considering prophylactic LAAO during cardiac surgery in patients without preoperative AF: lower observed thromboembolic and bleeding outcomes alongside more postoperative AF. Because the evidence combines different study designs and has low to moderate certainty, the estimates should inform discussion of uncertainty rather than be treated as definitive effects.
What to keep in mind
The evidence was rated low to moderate certainty and included both randomized and observational studies. Effect estimates varied across study design, surgery type, and LAAO technique.