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Review
. 2015 May;47(5):847-54.
doi: 10.1093/ejcts/ezu291. Epub 2014 Jul 26.

Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis

Yi-Chin Tsai  1 , Kevin Phan  2 , Stine Munkholm-Larsen  3 , David H Tian  4 , Mark La Meir  5 , Tristan D Yan  6
Affiliations
Review

Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis

Yi-Chin Tsai et al. Eur J Cardiothorac Surg. 2015 May.

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.

Keywords: Atrial fibrillation; Left atrial appendage; Meta-analysis; Surgical occlusion.

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