Key result
Surgical left atrial appendage occlusion improved freedom from cerebrovascular events compared to no-LAAO in sinus rhythm patients undergoing cardiac surgery (HR 0.482; 95% CI 0.361-0.643; P<0.001).
Why the study?
The clinical efficacy of surgical left atrial appendage occlusion in patients with sinus rhythm undergoing cardiac surgery remains controversial.
Does surgical left atrial appendage occlusion reduce cerebrovascular events and improve survival in patients in sinus rhythm undergoing cardiac surgery?
Meta-Analysis
Does surgical left atrial appendage occlusion reduce cerebrovascular events and improve survival in patients in sinus rhythm undergoing cardiac surgery?
Hazard Ratio: 0.482 (95% CI 0.361–0.643)
p-value: p=< .001
Surgical left atrial appendage occlusion during cardiac surgery in patients in sinus rhythm is associated with a significant reduction in cerebrovascular events and improved midterm survival without increasing postoperative atrial fibrillation.
Supports LAAO consideration during cardiac surgery in sinus rhythm; extends AF evidence with reduced cerebrovascular events and survival benefit.
BACKGROUND: The clinical efficacy of surgical occlusion of the left atrial appendage in patients with sinus rhythm undergoing cardiac surgery remains controversial. OBJECTIVE: This meta-analysis aims to evaluate the impact of left atrial appendage occlusion (LAAO) on early and late outcomes in sinus rhythm patients undergoing cardiac surgery. METHODS: Screened and selected studies were sourced from PubMed, Embase, and Web of Science databases, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Early clinical outcomes were pooled using odds ratio, and long-term outcomes were extracted from Kaplan-Meier curves to reconstruct individual time-to-event patient data and allow for proportional hazards regression. Bias-treated data were selected when available. RESULTS: = 46%; P = .246). Reconstruction of Kaplan-Meier data revealed greater freedom from cerebrovascular events in the LAAO group than in the no-LAAO group (hazard ratio 0.482; 95% CI 0.361-0.643; P < .001). The LAAO group also demonstrated improved midterm survival (hazard ratio 0.701; 95% CI 0.554-0.886; P = .003). CONCLUSION: This meta-analysis has demonstrated an improved freedom from cerebrovascular events and a midterm survival benefit in sinus rhythm patients undergoing cardiac surgery and surgical LAAO. This meta-analysis does not demonstrate an increased occurrence of postoperative atrial fibrillation in the LAAO group. Larger randomized controlled trials, stratified by cardiac pathology, are required to validate these findings.
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Burton et al. (2025) conducted a meta-analysis in Sinus rhythm patients undergoing cardiac surgery. Surgical left atrial appendage occlusion (LAAO) vs. No-LAAO was evaluated on Freedom from cerebrovascular events (HR 0.482, 95% CI 0.361-0.643, p=< .001). Surgical left atrial appendage occlusion improved freedom from cerebrovascular events compared to no-LAAO in sinus rhythm patients undergoing cardiac surgery (HR 0.482; 95% CI 0.361-0.643; P<0.001).
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