Related Experiment Video
Updated: Aug 2, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Left atrial appendage closure during cardiac surgery: Safe but underutilized in California
Joseph Hadaya1, Roland Hernandez2, Yas Sanaiha1
1Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
Insights
Left atrial appendage (LAA) closure in atrial fibrillation (AF) patients undergoing cardiac surgery reduces stroke risk. Despite increased use, significant hospital variations in LAA closure practices persist, indicating a need for standardized care.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Device Technology
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with an increased risk of stroke.
- Left atrial appendage (LAA) closure is an established method to mitigate stroke risk in AF patients.
- The utilization and outcomes of LAA closure in patients undergoing concomitant cardiac surgery require ongoing evaluation.
Purpose of the Study:
- To assess trends in LAA closure rates among cardiac surgery patients with AF in California.
- To determine the association between LAA closure and the incidence of stroke/systemic embolism.
- To evaluate the safety profile of LAA closure and identify hospital-level variations in its use.
Main Methods:
- Retrospective analysis of adult patients with AF undergoing coronary artery bypass grafting and/or valve surgery (2016-2019).
- Utilized California Office of Statewide Health Planning and Development databases.
- Employed propensity score matching to compare outcomes and intraclass correlation coefficients for hospital variation analysis.
Main Results:
- LAA closure was performed in 47.7% of 18,434 AF patients, with rates increasing from 44.4% to 51.4% (2016-2019).
- In matched patients, LAA closure significantly reduced stroke/systemic embolism at discharge (1.6% vs 3.1%) and 1-year readmission (2.9% vs 4.5%).
- No increased risk of acute kidney injury, pulmonary complications, transfusion, reoperation, or mortality was observed; 18% of variation in LAA use was hospital-attributed.
Conclusions:
- LAA closure in AF patients undergoing cardiac surgery is safe and effective in reducing short- and midterm stroke/systemic embolism.
- Despite increasing adoption, significant hospital-level variation in LAA closure practices exists in California.
- Standardization of LAA closure protocols is recommended to optimize patient care and outcomes.
Objective:
Left atrial appendage (LAA) closure is associated with reduced rates of stroke in patients with atrial fibrillation (AF). We evaluated trends in LAA closure, the association of LAA closure with stroke/systemic embolism, and its safety profile in patients with AF who underwent cardiac surgery in California. We further tested for hospital-level variation in concomitant LAA closure.
Methods:
Adults who underwent coronary artery bypass grafting and/or valve surgery with preoperative AF were identified in the 2016 to 2019 Office of Statewide Health Planning and Development databases. Propensity score matching was performed to study risk-adjusted associations of LAA closure with ischemic stroke/systemic embolism. Hospital-level variation was studied using intraclass correlation coefficients.
Results:
Among 18,434 patients with AF who underwent coronary artery bypass grafting/valve surgery, 47.7% received LAA closure. Rates of LAA closure increased from 44.4% to 51.4% from 2016 to 2019 (P < .001). In 4652 propensity score-matched patients, LAA closure was associated with reduced incidence of stroke/systemic embolism at discharge (1.6% vs 3.1%; P < .001) and readmission with stroke/systemic embolism at 1 year (2.9% vs 4.5%; P = .004). LAA closure was not associated with acute kidney injury, pulmonary complications, blood transfusion, reoperation, or in-hospital mortality. Approximately 18% of the risk-adjusted variation in LAA use was attributed to the hospital, with median center-level rate of 44.9% (interquartile range, 29.6%-57.4%).
Conclusions:
LAA closure was associated with minimal surgical morbidity, and reduced short- and midterm incidence of stroke/systemic embolism. Although the use of LAA closure has increased, substantial variation exists among programs in California, suggesting the need for further standardization of care.
