Concomitant Surgical Left Atrial Appendage Occlusion: a Review

Area of Science:

• Cardiology
• Cardiac Surgery
• Stroke Prevention

Background:

• Atrial fibrillation (AF) is prevalent in cardiac surgery patients.
• Oral anticoagulants are the established standard for AF-related stroke prevention.
• The left atrial appendage is a primary source of stroke-causing emboli in AF patients.

Purpose of the Study:

• To review observational data on left atrial appendage occlusion (LAAO) for stroke prevention.
• To highlight the findings of the Left Atrial Appendage Occlusion Study (LAAOS) III.
• To identify future research priorities for surgical LAAO.

Main Methods:

• Review of observational studies on LAAO.
• Analysis of the LAAOS III randomized controlled trial results.
• Discussion of current and future research directions.

Main Results:

• The LAAOS III trial demonstrated that surgical LAAO reduces stroke/systemic embolism risk in AF patients undergoing cardiac surgery.
• Concomitant LAAO provides additional benefit beyond oral anticoagulation.
• Surgical LAAO is effective for AF patients with CHA 2 DS 2 -VASc score ≥ 2.

Conclusions:

• Surgical left atrial appendage occlusion is a beneficial adjunct for stroke prevention in cardiac surgery patients with atrial fibrillation.
• Further research is needed to clarify the role of LAAO in non-AF patients and as a standalone procedure.