Left Atrial Appendage Closure During Cardiac Surgery for Atrial Fibrillation: A Meta-Analysis.

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Atrial fibrillation (AF) is a common arrhythmia associated with increased stroke risk.
• Left atrial appendage closure (LAAC) is a strategy to reduce stroke in AF patients.
• The efficacy and safety of LAAC during cardiac surgery remain under investigation.

Purpose of the Study:

• To comprehensively review and analyze studies comparing LAAC with no LAAC during cardiac surgery in AF patients.
• To evaluate the impact of LAAC on postoperative stroke/embolic events, mortality, and safety outcomes.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials and observational studies.
• Inclusion of studies comparing LAAC to a placebo or no LAAC group in AF patients undergoing cardiac surgery.
• Random-effect model used to calculate risk ratios and confidence intervals.

Main Results:

• LAAC significantly decreased postoperative stroke/embolic events in all cardiac surgeries and isolated valvular surgery.
• Coronary artery bypass grafting (CABG) showed a non-significant trend favoring LAAC for stroke reduction.
• LAAC demonstrated significantly lower two-year all-cause mortality, with no difference in perioperative mortality, major bleeding, or rehospitalizations.

Conclusions:

• LAAC during cardiac surgery in AF patients is associated with a reduced risk of stroke and long-term mortality.
• The procedure does not increase major bleeding, all-cause rehospitalizations, or cross-clamp time.
• LAAC is a safe and effective adjunctive therapy for stroke prevention in AF patients undergoing cardiac surgery.