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August 14, 2026Asian Cardiovascular and Thoracic Annals

Prophylactic surgical LAA exclusion in sinus rhythm lacks definitive evidence to support routine use.

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Why the study?

Surgical LAA exclusion has increasingly been used routinely during cardiac surgery in patients presenting in sinus rhythm before its net clinical value and care pathway have been clearly established.

Population

Patients in sinus rhythm undergoing cardiac surgery

Design

Editorial

Key result

Prophylactic surgical left atrial appendage exclusion in patients with sinus rhythm lacks definitive evidence of net clinical value and warrants disciplined evaluation rather than routine use.

Authors

JSJeffrey Shuhaiber

Discussion

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Overview

LAA exclusion in sinus rhythm during cardiac surgery remains unproven; leaves open whether routine use improves outcomes.

Key Points

  • To evaluate the clinical evidence, potential benefits, and postoperative risks of routine prophylactic left atrial appendage exclusion in cardiac surgery patients presenting in sinus rhythm.
  • Reviewed contemporary clinical studies and real-world outcome data on surgical left atrial appendage (LAA) exclusion in non-atrial fibrillation cohorts.
  • Evaluated reported cerebrovascular event rates, postoperative atrial fibrillation incidence, and downstream anticoagulation exposure.
  • Observed potential reductions in late cerebrovascular events in risk-enriched cohorts, but findings remain heterogeneous and context-dependent.
  • Identified significant early clinical burdens associated with the intervention, including postoperative atrial fibrillation and variability in subsequent anticoagulation management.
  • Concluded that routine adoption of prophylactic LAA exclusion in sinus rhythm has outpaced definitive evidence establishing its net clinical benefit.

Structured PICO

P
Population
Patients in sinus rhythm undergoing cardiac surgery
I
Intervention
Prophylactic surgical left atrial appendage (LAA) exclusion

Prophylactic surgical LAA exclusion in patients with sinus rhythm lacks definitive evidence and warrants disciplined evaluation rather than routine use.

Cite This Study

Jeffrey Shuhaiber (2026) conducted an editorial in Patients undergoing cardiac surgery in sinus rhythm. Surgical left atrial appendage (LAA) exclusion was evaluated. Prophylactic surgical left atrial appendage exclusion in patients with sinus rhythm lacks definitive evidence of net clinical value and warrants disciplined evaluation rather than routine use.

synapsesocial.com/papers/6a7ec78db70b84ec8b913fa1https://doi.org/10.1177/02184923261478978
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Incomplete surgical ligation of the left atrial appendage—time for a new look at an old problem2017 · 14 citations
  2. 2Advances in Left Atrial Appendage Occlusion Strategies.2013 · 2 citations
  3. 3Routine left atrial appendage occlusion in patients undergoing cardiac surgery: a narrative review2021 · 1 citations
  4. 4The Left Atrial Appendage: Target for Stroke Reduction in Atrial Fibrillation2015 · 36 citations
  5. 5Non-Surgical Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation2011 · 12 citations