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Updated: Apr 26, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a
Yi-Chin Tsai1, Kevin Phan2, Stine Munkholm-Larsen3
1Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia.
Insights
Left atrial appendage occlusion (LAAO) during cardiac surgery significantly reduces stroke and mortality in atrial fibrillation patients. This meta-analysis confirms LAAO as a promising stroke reduction strategy without increasing complications.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Atrial fibrillation (AF) poses a significant stroke risk.
- Left atrial appendage occlusion (LAAO) during surgical ablation is a strategy to mitigate this risk.
- Evidence comparing LAAO with LAA preservation during cardiac surgery is limited.
Purpose of the Study:
- To assess the efficacy and safety of concomitant LAAO versus LAA preservation in patients undergoing cardiac surgery.
- To evaluate the impact of LAAO on stroke, mortality, postoperative AF, and bleeding complications.
Main Methods:
- A meta-analysis of comparative randomized and observational studies.
- Searched six electronic databases from inception to November 2013.
- Analyzed data from 3653 patients (1716 LAAO, 1937 non-LAAO) for mortality, stroke, postoperative AF, and reoperation for bleeding.
Main Results:
- LAAO significantly reduced stroke incidence at 30-day (0.95% vs 1.9%) and latest follow-up (1.4% vs 4.1%).
- All-cause mortality was significantly decreased in the LAAO group (1.9% vs 5%).
- Postoperative AF and reoperation for bleeding rates were comparable between groups.
Conclusions:
- LAAO appears to be a promising strategy for perioperative stroke reduction in AF patients undergoing cardiac surgery.
- The procedure did not significantly increase complications in this meta-analysis.
- Larger randomized trials with clear protocols and long-term follow-up are needed to validate these findings.
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.
