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Review
. 2022 Apr 26:40:100998.
doi: 10.1016/j.ijcha.2022.100998. eCollection 2022 Jun.

Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysis

Nso Nso  1 , Mahmoud Nassar  1 , Milana Zirkiyeva  1 , Sofia Lakhdar  1 , Tanveer Shaukat  1 , Laura Guzman  1 , Mohsen Alshamam  1 , Allison Foster  1 , Rubal Bhangal  1 , Solomon Badejoko  2 , Anthony Lyonga Ngonge  3 , Mpey Tabot-Tabot  3 , Yolanda Mbome  4 , Vincent Rizzo  1 , Most S Munira  5 , Senthil Thambidorai  6
Affiliations
Review

Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysis

Nso Nso et al. Int J Cardiol Heart Vasc. .

Abstract

Surgical left atrial appendage occlusion (LAAO) is being used increasingly in the setting of atrial fibrillation but has been associated with procedural complications. This systematic review and meta-analysis compared the outcomes of surgical LAAO with those of no LAAO and the use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) using the PRISMA guidelines. A literature search was undertaken for relevant studies published between January 1, 2003, and August 15, 2021. Primary clinical outcomes were all-cause mortality, embolic events, and stroke. Secondary clinical outcomes included major adverse cardiac events (MACE), postoperative atrial fibrillation, postoperative complications, reoperation for bleeding, and major bleeding. There was a statistically significant 34% reduction in incidence of embolic events (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.57-0.77, p < 0.001) and a significant 42% reduction in risk of MACE (OR 0.58, 95% CI 0.38-0.88, p = 0.01) in patients who underwent LAAO.Surgical LAAO has the potential to reduce embolic events and MACE in patients undergoing cardiac surgery for atrial fibrillation. However, complete replacement of DOACs and warfarin therapy with surgical LAAO is unlikely despite its non-inferiority in terms of minimizing all-cause mortality, embolic events, MACE, major bleeding, and stroke in patients on oral anticoagulation therapies.

Keywords: AF, atrial fibrillation; All-cause mortality; Atrial fibrillation; CI, confidence interval; DOACs, direct oral anticoagulants; Direct oral anticoagulants; LA, left atrium; LAA, left atrial appendage; LAAO, left atrial appendage occlusion; Left atrial appendage occlusion; MACE, major adverse cardiac events; NOACs, novel oral anticoagulants; OR, odds ratio; Stroke; VKAs, vitamin K antagonists; Vitamin K antagonists.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Risk of bias graph.
Fig. 2a
Fig. 2a
Risk of bias summary.
Fig. 2b
Fig. 2b
PRISMA Flow Diagram.
Fig. 2c
Fig. 2c
All-cause mortality (Forest plot).
Fig. 2d
Fig. 2d
Embolic events (Forest plot).
Fig. 2e
Fig. 2e
Stroke (Forest plot).
Fig. 2f
Fig. 2f
MACE (Forest plot).
Fig. 3
Fig. 3
Postoperative atrial fibrillation (Forest plot).
Fig. 4a
Fig. 4a
Postoperative complications (Forest plot).
Fig. 4b
Fig. 4b
Reoperation for bleeding (Forest plot).
Fig. 4c
Fig. 4c
All-cause mortality (Forest plot).
Fig. 4d
Fig. 4d
Embolic events (Forest plot).
Fig. 4e
Fig. 4e
Stroke (Forest plot).
Fig. 4f
Fig. 4f
MACE (Forest plot).
Fig. 5
Fig. 5
Major bleeding (Forest plot).
Fig. 6a
Fig. 6a
All-cause mortality (Forest plot).
Fig. 6b
Fig. 6b
Embolic events (Forest plot).
Fig. 6c
Fig. 6c
Stroke (Forest plot).
See this image and copyright information in PMC

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