Percutaneous or surgical LAAO for stroke prevention in patients with atrial fibrillation: A network meta-analysis

• Published in: Heliyon 2024-09, Vol.10 (18), p.e37730, Article e37730
• Main Authors: Zhao, Zihan, Yang, Changjiang, Zhang, Wenchang, He, Changjian, Ye, Guojie, liu, Tengfei, Ding, Chunhua
• Format: Article
• Language: English
• Subjects: Atrial fibrillation; Network meta-analysis; Percutaneous left atrial appendage occlusion; Stroke prevention; Surgical left atrial appendage occlusion
• ISSN: 2405-8440; 2405-8440
• DOI: 10.1016/j.heliyon.2024.e37730

Stroke, which is mainly caused by thrombus formation in the left atrial appendage, represents the most prevalent complication of atrial fibrillation (AF). Both percutaneous left atrial appendage occlusion (p-LAAO) and surgical LAAO (s-LAAO) are used to treat AF and prevent stroke events. However, no head-to-head randomized controlled trials (RCTs) compared these strategies. To examine the efficacy and safety of diverse strategies for reducing stroke risk using a network meta-analysis (NMA). PubMed, EMBASE, and Cochrane repositories were explored to identify RCTs involving p-LAAO or s-LAAO, and five were included for NMA. This investigation adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The NMA was pooled using the Bayesian random effect framework. All findings were expressed as odds ratios accompanied by a 95 % confidence interval. The primary efficacy endpoint was any stroke (AS), and the secondary efficacy endpoint was combined AS and systematic embolism (AS/SE). The primary and secondary safety endpoints were major bleeding (MB) and all-cause death (ACD), respectively. Our meta-analysis incorporated 6337 individuals diagnosed with AF. The NMA demonstrated a reducing trend in AS and AS/SE for s-LAAO versus p-LAAO, while p-LAAO showed a benefit in reducing MB and ACD. and Relevance: s-LAAO could potentially benefit individuals at elevated risk for stroke, whereas p-LAAO may be linked to a reduced likelihood of bleeding.