Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation

A meta-analysis

Yi Chin Tsai, Kevin Phan, Stine Munkholm-larsen, David H. Tian, Mark La meir, Tristan D. Yan*

*Corresponding author for this work

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

OBJECTIVES: Concomitant left atrial appendage occlusion (LAAO) during surgical ablation has emerged as a potential treatment strategy to reduce stroke and perioperative mortality in patients with atrial fibrillation (AF). The present meta-analysis aims to assess current evidence on the efficacy and safety between LAAO and LAA preservation cohorts for patients undergoing cardiac surgery. METHODS: Electronic searches were performed using six electronic databases from their inception to November 2013, identifying all relevant comparative randomized and observational studies comparing LAAO with non-LAAO in AF patients undergoing cardiac surgery. Data were extracted and analysed according to predefined endpoints including mortality, stroke, postoperative AF and reoperation for bleeding. RESULTS: Seven relevant studies identified for qualitative and quantitative analyses, including 3653 patients undergoing LAAO (n = 1716) versus non-LAAO (n = 1937). Stroke incidence was significantly reduced in the LAAO occlusion group at the 30-day follow-up [0.95 vs 1.9%; odds ratio (OR) 0.46; P = 0.005] and the latest follow-up (1.4 vs 4.1%; OR 0.48; P = 0.01), compared with the non-LAAO group. Incidence of all-cause mortality was significantly decreased with LAAO (1.9 vs 5%; OR 0.38; P = 0.0003), while postoperative AF and reoperation for bleeding was comparable. CONCLUSIONS: While acknowledging the limitations and inadequate statistical power of the available evidence, this study suggests LAAO as a promising strategy for stroke reduction perioperatively and at the short-term follow-up without a significant increase in complications. Larger randomized studies in the future are required, with clearer surgical and anticoagulation protocols and adequate long-term follow-up, to validate the clinical efficacy of LAAO versus non-LAAO groups.

Original languageEnglish
Article numberezu291
Pages (from-to)847-854
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume47
Issue number5
Early online date26 Jul 2014
DOIs
Publication statusPublished - May 2015

Keywords

  • Atrial fibrillation
  • Surgical occlusion
  • Left atrial appendage
  • Meta-analysis

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