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Percutaneous or surgical LAAO for stroke prevention in patients with atrial fibrillation: A network meta-analysis

Zihan Zhao1,2, Changjiang Yang3, Wenchang Zhang1,2

  • 1Aerospace Center Hospital, China.

Heliyon
|September 26, 2024
PubMed

Insights

Surgical left atrial appendage occlusion (s-LAAO) may reduce stroke risk in atrial fibrillation (AF) patients, while percutaneous LAAO (p-LAAO) shows benefits in reducing bleeding and death. Further research is needed to compare these stroke prevention strategies.

Area of Science:

  • Cardiology
  • Medical Interventions
  • Public Health

Background:

  • Atrial fibrillation (AF) is a common condition associated with a high risk of stroke due to thrombus formation in the left atrial appendage (LAA).
  • Left atrial appendage occlusion (LAAO) is a strategy to prevent stroke in AF patients, with both percutaneous (p-LAAO) and surgical (s-LAAO) approaches available.
  • Currently, head-to-head randomized controlled trials comparing p-LAAO and s-LAAO are lacking.

Purpose of the Study:

  • To conduct a network meta-analysis (NMA) comparing the efficacy and safety of different LAAO strategies for stroke risk reduction in AF patients.
  • To evaluate outcomes including any stroke (AS), combined AS and systemic embolism (AS/SE), major bleeding (MB), and all-cause death (ACD).

Main Methods:

  • A systematic literature search was performed across PubMed, EMBASE, and Cochrane repositories to identify relevant randomized controlled trials (RCTs).
  • Five RCTs were included in the NMA, adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
  • A Bayesian random-effects model was employed for data pooling, with findings reported as odds ratios and 95% confidence intervals.

Main Results:

  • The meta-analysis included data from 6337 patients with AF.
  • A trend towards reduced any stroke (AS) and combined AS/SE was observed with surgical LAAO (s-LAAO) compared to percutaneous LAAO (p-LAAO).
  • Percutaneous LAAO (p-LAAO) demonstrated a significant benefit in reducing major bleeding (MB) and all-cause death (ACD).

Conclusions:

  • Surgical LAAO (s-LAAO) may offer potential benefits for patients at higher risk of stroke.
  • Percutaneous LAAO (p-LAAO) appears to be associated with a lower incidence of bleeding complications.
  • The findings suggest distinct risk-benefit profiles for s-LAAO and p-LAAO, informing clinical decision-making for stroke prevention in AF.
Abstract

Keywords:
Atrial fibrillationNetwork meta-analysisPercutaneous left atrial appendage occlusionStroke preventionSurgical left atrial appendage occlusion

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