Surgical left atrial appendage occlusion during cardiac surgery: A systematic review and meta-analysis

Abstract

AIMTo evaluate the safety and efficacy of surgical left atrial appendage occlusion (s-LAAO) during concomitant cardiac surgery.METHODSWe performed a comprehensive literature search through May 31st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation (AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF predominance.RESULTSTwelve studies (n = 40107) met the inclusion criteria. s-LAAO was associated with lower risk of embolic events (OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke (OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001). Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of all-cause mortality, AF, and reoperation for bleeding and postoperative complications.CONCLUSIONConcomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.

Surgical Ablation of Permanent Atrial Fibrillation: Age, LV Dilatation, Obesity

“…19,20 We terminated anticoagulation not earlier than after 6 months of FREEAF as we were aware of endocardial, wound-associated thromboembolism. Similar to a former meta-analysis, 25 we had no evidence for stroke, peripheral thromboembolism, or bleeding disorders. Thus, another benefit to FAP patients is the termination of anticoagulation.…”

Surgical left atrial appendage occlusion in patients with atrial fibrillation undergoing mechanical heart valve replacement

“…We did not identify any differences between the groups regarding in-hospital complications, similar to previous studies. [ 11 , 13 , 27 ] However, our results showed that SLAAO was associated with longer length of stay, and longer CPB and aortic cross-clamp times, suggesting that this technique may still increase the burden of perioperative complications, to some extent.…”

“…[ 5 , 19 ] However, there is no conclusive evidence that SLAAO reduces stroke risk in patients with atrial fibrillation undergoing cardiac surgery. Recently, several retrospective studies [ 9 , 10 , 20 ] and meta-analyses [ 11 – 13 ] showed that SLAAO is associated with a lower incidence of ischemic stroke or systemic embolism and mortality in patients undergoing cardiac surgery. Friedman et al [ 10 ] published a retrospective study involving 10,524 patients aged ≥65 years with atrial fibrillation undergoing cardiac surgery and found that SLAAO was associated with a significantly lower risk of readmission for thromboembolism and all-cause mortality during a 3-year follow-up.…”

“…[ 6 – 8 ] Several studies have examined the relationship between concomitant SLAAO during cardiac surgery and cardiovascular outcomes, but with divergent results. Recently, two large observational studies [ 9 , 10 ] and several meta-analyses [ 11 – 13 ] comparing patients who underwent SLAAO with those who did not, demonstrated that SLAAO during cardiac surgery was associated with a lower risk of thromboembolism, stroke, and mortality. Conversely, other studies found that concomitant SLAAO and cardiac surgery did not influence the risk of stroke or mortality.…”

Women and atrial fibrillation

“…Success rates vary according to surgical procedure with highest success with excision/amputation techniques 78 . A recent meta‐analysis concluded that surgical LAAO was associated with a lower risk of thromboembolic events and stroke 79 . In a retrospective cohort of 75,782 adults with LAAO during cardiac surgery, with 29% women, the hazard ratio for stroke was higher in women [0.80 (0.51–1.25)] than men [0.59 (95% CI, 0.39–0.91)] among propensity‐matched patients with AF at baseline 80 .…”