Related Experiment Video
Updated: May 2, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Stroke prevention strategies for cardiac surgery: a systematic review and meta-analysis of randomized controlled
Khi Yung Fong1, Selvie Yeo1, Haidong Luo2
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Insights
This review found left atrial appendage closure (LAAC) significantly reduces stroke risk in cardiac surgery patients with atrial fibrillation. Further research is needed to optimize stroke prevention strategies.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Clinical Trials
Background:
- Stroke is a significant complication following cardiac surgery.
- Existing literature on stroke prevention strategies is fragmented.
- This systematic review and meta-analysis addresses this gap.
Approach:
- Conducted an electronic literature search for randomized controlled trials (RCTs) on perioperative interventions for cardiac surgery with stroke as an outcome.
- Performed random-effects meta-analyses to calculate risk ratios (RRs) and confidence intervals (CIs).
- Conducted descriptive analysis for interventions not suitable for meta-analysis.
Key Points:
- Fifty-six RCTs involving 61,894 patients were reviewed.
- Left atrial appendage closure (LAAC) significantly reduced stroke risk in patients with preoperative atrial fibrillation (RR=0.55, 95% CI=0.36-0.84).
- Preoperative amiodarone showed potential benefit in one trial; remote ischemic preconditioning did not reduce stroke or MACE rates.
Conclusions:
- Left atrial appendage closure (LAAC) should be considered for stroke risk reduction in cardiac surgery patients with atrial fibrillation.
- Identifies research gaps and the need for large-scale RCTs for stroke prevention in cardiac surgery.
- Highlights the fragmented nature of current evidence on stroke prevention strategies.
Background:
Stroke is a much-feared complication of cardiac surgery, but existing literature on preventive strategies is fragmented. Hence, a systematic review and meta-analysis of stroke prevention strategies for cardiac surgery was conducted.
Methods:
An electronic literature search was conducted to retrieve randomized controlled trials (RCTs) investigating perioperative interventions for cardiac surgery, with stroke as an outcome. Random-effects meta-analyses were conducted to generate risk ratios (RRs), 95% confidence intervals (95% CI), and forest plots. Descriptive analysis and synthesis of literature was conducted for interventions not amenable to meta-analysis, focusing on risks of stroke, myocardial infarction and study-defined major adverse cardiovascular events (MACE).
Results:
Fifty-six RCTs (61 894 patients) were retrieved. Many included trials were underpowered to detect differences in stroke risk. Among pharmacological therapies, only preoperative amiodarone was shown to reduce stroke risk in one trial. Concomitant left atrial appendage closure (LAAC) significantly reduced stroke risk (RR = 0.55, 95% CI = 0.36-0.84, P = 0.006) in patients with preoperative atrial fibrillation, and there was no difference in on-pump versus off-pump coronary artery bypass grafting (CABG) (RR = 0.94, 95% CI = 0.64-1.37, P = 0.735). Much controversy exists in literature on the timing of carotid endarterectomy relative to CABG in patients with severe carotid stenosis. The use of preoperative remote ischemic preconditioning was not found to reduce rates of stroke or MACE.
Conclusion:
This review presents a comprehensive synthesis of existing interventions for stroke prevention in cardiac surgery, and identifies gaps in research which may benefit from future, large-scale RCTs. LAAC should be considered to reduce stroke incidence in patients with preoperative atrial fibrillation.
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:29Venous Thrombosis III: Interprofessional Care