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Updated: Jan 4, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Beneficial effect of left atrial appendage closure during cardiac surgery: a meta-analysis of 280 585 patients
Elio Martín Gutiérrez1, Mario Castaño1, Javier Gualis1
1Servicio de Cirugía Cardiaca, Hospital Universitario de León - CAULE, León, Spain.
Insights
Surgical left atrial appendage closure (LAAC) significantly reduces stroke and embolic events in patients undergoing cardiac surgery. This meta-analysis confirms LAAC
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Technology
Background:
- The left atrial appendage (LAA) is a primary source of emboli in non-rheumatic atrial fibrillation (AF).
- Percutaneous LAA closure (LAAC) is non-inferior to medical treatment for stroke prevention.
- Surgical LAAC has a IIb guideline recommendation, necessitating further investigation in surgical populations.
Purpose of the Study:
- To evaluate the efficacy of concomitant surgical left atrial appendage closure (LAAC) in reducing stroke and embolic events.
- To assess the impact of surgical LAAC on perioperative and long-term mortality.
- To investigate the benefit of surgical LAAC based on the prevalence of preoperative atrial fibrillation (AF).
Main Methods:
- A meta-analysis was conducted on 22 studies involving 280,585 patients undergoing cardiac surgery.
- Studies compared outcomes of cardiac surgery with or without concomitant surgical LAAC.
- Data on stroke/embolic events and mortality were analyzed from study inception to January 2019.
Main Results:
- Surgical LAAC significantly reduced perioperative stroke/embolic events (RR 0.66) and those during >2 years follow-up (RR 0.67).
- LAAC demonstrated a protective effect in studies with >70% preoperative AF (RR 0.64) but not in those with <30% (RR 0.77).
- Postoperative mortality was significantly lower in patients with surgical LAAC at mid- and long-term follow-up (RR 0.72).
Conclusions:
- Concomitant surgical LAAC is associated with reduced embolic events and stroke in patients with preoperative AF.
- Surgical LAAC improves mid- and long-term postoperative mortality rates.
- These findings support the use of surgical LAAC in appropriate cardiac surgery patients.
Abstract:
In non-rheumatic atrial fibrillation (AF), left atrial appendage (LAA) is thought to be the source of embolism in 90% of the strokes. Thus, as recent clinical trials have shown the non-inferiority of percutaneous LAA closure (LAAc) in comparison to medical treatment, and despite a IIb recommendation in the latest guidelines for concomitant surgical LAAc, we sought to investigate the beneficial effect of LAAc in the surgical population. A meta-analysis model was performed comparing studies including any cardiac surgery with or without concomitant surgical LAAc reporting stoke/embolic events and/or mortality, from inception to January 2019. Twenty-two studies (280 585 patients) were included in the model. Stroke/embolic events both in the perioperative period [relative risk (RR) 0.66, 95% confidence interval (CI) 0.53-0.82; P = 0.0001] and during follow-up of >2 years (RR 0.67, 95% CI 0.51-0.89; P < 0.005) were significantly reduced in patients who underwent surgical LAAc (RR 0.71, 95% CI 0.58-0.87; P = 0.001). Regarding the rate of preoperative AF, LAAc showed protective effect against stroke/embolic events in studies with >70% preoperative AF (RR 0.64, 95% CI 0.53-0.77; P < 0.00001) but no benefit in the studies with <30% of preoperative AF (RR 0.77, 95% CI 0.46-1.28; P = 0.31). Postoperative mortality was also significantly lower in surgical patients with LAAc at the mid- and long-term follow-up. (RR 0.72, 95% CI 0.67-0.78; P < 0.00001; I2 = 0%). Based on these findings, concomitant surgical LAAc is associated with lower rates of embolic events and stroke in the postoperative period in patients with preoperative AF and also improves postoperative mortality in the mid- and long-term follow-up.
