Key result
Prophylactic LAAO during cardiac surgery cuts early thromboembolic events by ~58%.
Why the study?
The efficacy of prophylactic concomitant left atrial appendage occlusion during cardiac surgery in patients without known atrial fibrillation remains unknown.
Does prophylactic concomitant LAAO reduce postoperative thromboembolic complications and POAF in patients undergoing cardiac surgery with no known history of atrial fibrillation?
Meta-Analysis (n=7,369)
Does prophylactic concomitant LAAO reduce postoperative thromboembolic complications and POAF in patients undergoing cardiac surgery with no known history of atrial fibrillation?
Relative Risk: 0.42 (95% CI 0.25–0.73)
Absolute Risk Reduction: 0.8%
p-value: p=0.002
Prophylactic LAAO during cardiac surgery in patients without prior AF significantly reduces early and all-time thromboembolic events, though it may increase the risk of postoperative AF.
Supports prophylactic LAAO in cardiac surgery for thromboembolic reduction; extends meta-analytic evidence while flagging POAF risk for further study.
Recently, concomitant left atrial appendage occlusion (LAAO) has emerged as prophylactic treatment option for preventing thromboembolic events in patients undergoing cardiac surgery with no known history of atrial fibrillation. The efficacy of prophylactic LAAO remains unknown. PubMed, Embase, Web of Science, Emcare, and the Cochrane Library were searched for studies on prophylactic LAAO in patients undergoing cardiac surgery. The primary endpoints were postoperative thromboembolic complications and postoperative atrial fibrillation (POAF). Three randomized trials and seven retrospective observational studies were included: in total, 7369 patients received either prophylactic LAAO ( n = 3823) or no prophylactic LAAO ( n = 3546) during their index cardiac surgery. Prophylactic LAAO reduced the risk of early thromboembolic events by 58 % (risk ratio: 0.42; 95 % confidence interval: 0.25 to 0.73; p = 0.002; I 2 = 0 %) with an estimated absolute risk reduction of 0.8 %. On the other hand, a higher risk, albeit statistically not significant, of POAF was seen with LAAO (risk ratio: 1.15; 95 % confidence interval: 1.00 to 1.32; p = 0.051; I 2 = 64 %). Prophylactic LAAO also reduced the risk of all-time thromboembolic complications by 52 % (hazards ratio: 0.48; 95 % CI: 0.29 to 0.80; p = 0.005; I 2 = 41 %). Prophylactic LAAO was associated with a reduction in early and all-time thromboembolic events but demonstrated a potential relation to a higher risk of POAF.
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Zhao et al. (2025) conducted a meta-analysis in cardiac surgery with no known history of atrial fibrillation (n=7,369). Prophylactic concomitant left atrial appendage occlusion vs. no prophylactic LAAO was evaluated on early thromboembolic events (RR 0.42, 95% CI 0.25 to 0.73, p=0.002). Prophylactic left atrial appendage occlusion during cardiac surgery reduced early thromboembolic events by 58% (RR 0.42; 95% CI 0.25-0.73; p=0.002) with an absolute risk reduction of 0.8%.
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