Left Atrial Appendage Occlusion During Cardiac Surgery to Prevent Stroke: A Systematic Review and Meta-Analysis

Atrial fibrillation accounts for 1/6 of all strokes, potentially leading to significant disability and death. The left atrial appendage (LAA) is the primary location for thrombus formation. Excluding the LAA has been hypothesized to decrease the risk of ischemic stroke. This study examines LAA occlu...

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Published in:The American journal of cardiology 2025-02, Vol.236, p.8-19
Main Authors: Sayed, Alaa, Kamal, Abdallah, Kamal, Ibrahim, Fathallah, Ahmed Hashem, Nourelden, Anas Zakarya, Zaidi, Syed Arsalan
Format: Article
Language:English
Subjects:
anticoagulation
Appendages
atrial fibrillation
Cardiac arrhythmia
cardiac surgery
Clinical outcomes
Clinical trials
Data analysis
Diabetes
Embolism
Health risks
Heart
Heart surgery
Hypertension
Ischemia
left atrial appendage
Meta-analysis
Mortality
Observational studies
Occlusion
Older people
Population studies
Postoperative period
Risk
Stroke
Surgery
Surgical outcomes
Systematic review
Thromboembolism
Thrombosis
Transient ischemic attack
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container_start_page 8
container_title The American journal of cardiology
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creator Sayed, Alaa
Kamal, Abdallah
Kamal, Ibrahim
Fathallah, Ahmed Hashem
Nourelden, Anas Zakarya
Zaidi, Syed Arsalan
description Atrial fibrillation accounts for 1/6 of all strokes, potentially leading to significant disability and death. The left atrial appendage (LAA) is the primary location for thrombus formation. Excluding the LAA has been hypothesized to decrease the risk of ischemic stroke. This study examines LAA occlusion (LAAO) with otherwise indicated cardiac surgery and its effect on surgical outcomes. We followed the standards recommended by the Cochrane Collaborative Group and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to prepare this systematic review and meta-analysis. Studies were retrieved through an online bibliographic search, studies were screened, and data were extracted. We compared the 2 study arms (LAAO and cardiac surgery without LAAO). A total of 10 studies have been included in this study, and 6 randomized controlled trials were included in the meta-analysis, with data pooled from over 10,000 patients. LAAO is associated with no significant difference in the overall mortality (p = 0.98) and systemic embolism (p = 0.31). Strokes, particularly, ischemic strokes, have significantly lower risk in patients who underwent LAAO (p
doi_str_mv 10.1016/j.amjcard.2024.10.024
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The left atrial appendage (LAA) is the primary location for thrombus formation. Excluding the LAA has been hypothesized to decrease the risk of ischemic stroke. This study examines LAA occlusion (LAAO) with otherwise indicated cardiac surgery and its effect on surgical outcomes. We followed the standards recommended by the Cochrane Collaborative Group and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to prepare this systematic review and meta-analysis. Studies were retrieved through an online bibliographic search, studies were screened, and data were extracted. We compared the 2 study arms (LAAO and cardiac surgery without LAAO). A total of 10 studies have been included in this study, and 6 randomized controlled trials were included in the meta-analysis, with data pooled from over 10,000 patients. LAAO is associated with no significant difference in the overall mortality (p = 0.98) and systemic embolism (p = 0.31). Strokes, particularly, ischemic strokes, have significantly lower risk in patients who underwent LAAO (p &lt;0.0001 and p = 0.0007), respectively. In conclusion, LAAO can be done safely as a concomitant surgery with other cardiac surgeries, with a minimal incremental cost when performed concurrently. LAAO is associated with a lower risk of all stroke and ischemic strokes. Further studies are needed to shape guidance on the continuation versus discontinuation of anticoagulation after LAAO, especially in patient populations with a higher risk of bleeding.</description><identifier>ISSN: 0002-9149</identifier><identifier>ISSN: 1879-1913</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2024.10.024</identifier><identifier>PMID: 39477201</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>anticoagulation ; Appendages ; atrial fibrillation ; Cardiac arrhythmia ; cardiac surgery ; Clinical outcomes ; Clinical trials ; Data analysis ; Diabetes ; Embolism ; Health risks ; Heart ; Heart surgery ; Hypertension ; Ischemia ; left atrial appendage ; Meta-analysis ; Mortality ; Observational studies ; Occlusion ; Older people ; Population studies ; Postoperative period ; Risk ; Stroke ; Surgery ; Surgical outcomes ; Systematic review ; Thromboembolism ; Thrombosis ; Transient ischemic attack</subject><ispartof>The American journal of cardiology, 2025-02, Vol.236, p.8-19</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). 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subjects anticoagulation
Appendages
atrial fibrillation
Cardiac arrhythmia
cardiac surgery
Clinical outcomes
Clinical trials
Data analysis
Diabetes
Embolism
Health risks
Heart
Heart surgery
Hypertension
Ischemia
left atrial appendage
Meta-analysis
Mortality
Observational studies
Occlusion
Older people
Population studies
Postoperative period
Risk
Stroke
Surgery
Surgical outcomes
Systematic review
Thromboembolism
Thrombosis
Transient ischemic attack
title Left Atrial Appendage Occlusion During Cardiac Surgery to Prevent Stroke: A Systematic Review and Meta-Analysis
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