Related Experiment Video
Updated: Jul 8, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Left Atrial Appendage Occlusion During Cardiac Surgery to Prevent Stroke: A Systematic Review and Meta-Analysis
Alaa Sayed1, Abdallah Kamal2, Ibrahim Kamal3
1Department of Medicine, Mercy Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Left atrial appendage occlusion (LAAO) during cardiac surgery significantly lowers stroke risk without impacting mortality. This procedure offers a safe and cost-effective stroke prevention strategy for atrial fibrillation patients.
Area of Science:
- Cardiology and Cardiovascular Surgery
- Stroke Prevention
- Medical Technology Assessment
Background:
- Atrial fibrillation is a major cause of stroke, with the left atrial appendage (LAA) being a primary site for thrombus formation.
- Excluding the LAA through left atrial appendage occlusion (LAAO) is hypothesized to reduce ischemic stroke risk.
- This study systematically reviews and meta-analyzes the safety and efficacy of LAAO performed concurrently with other cardiac surgeries.
Approach:
- A systematic review and meta-analysis adhering to Cochrane and PRISMA guidelines.
- Bibliographic searches identified relevant studies, followed by data extraction and comparison of LAAO versus no LAAO groups.
- Pooled data from 10 studies, including 6 randomized controlled trials with over 10,000 patients.
Key Points:
- LAAO demonstrated no significant difference in overall mortality (p = 0.98) or systemic embolism (p = 0.31).
- A significantly lower risk of all strokes (p < 0.0001) and ischemic strokes (p = 0.0007) was observed in patients undergoing LAAO.
- LAAO as a concomitant procedure is associated with minimal incremental cost.
Conclusions:
- Left atrial appendage occlusion can be safely performed concurrently with cardiac surgery.
- LAAO significantly reduces the risk of all strokes and ischemic strokes in patients with atrial fibrillation.
- Further research is needed to guide anticoagulation management post-LAAO, particularly in high-bleeding-risk populations.
Abstract:
Atrial fibrillation accounts for 1/6 of all strokes, potentially leading to significant disability and death. The left atrial appendage (LAA) is the primary location for thrombus formation. Excluding the LAA has been hypothesized to decrease the risk of ischemic stroke. This study examines LAA occlusion (LAAO) with otherwise indicated cardiac surgery and its effect on surgical outcomes. We followed the standards recommended by the Cochrane Collaborative Group and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to prepare this systematic review and meta-analysis. Studies were retrieved through an online bibliographic search, studies were screened, and data were extracted. We compared the 2 study arms (LAAO and cardiac surgery without LAAO). A total of 10 studies have been included in this study, and 6 randomized controlled trials were included in the meta-analysis, with data pooled from over 10,000 patients. LAAO is associated with no significant difference in the overall mortality (p = 0.98) and systemic embolism (p = 0.31). Strokes, particularly, ischemic strokes, have significantly lower risk in patients who underwent LAAO (p <0.0001 and p = 0.0007), respectively. In conclusion, LAAO can be done safely as a concomitant surgery with other cardiac surgeries, with a minimal incremental cost when performed concurrently. LAAO is associated with a lower risk of all stroke and ischemic strokes. Further studies are needed to shape guidance on the continuation versus discontinuation of anticoagulation after LAAO, especially in patient populations with a higher risk of bleeding.
