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Updated: May 6, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
The clinical impact of prophylactic concomitant left atrial appendage occlusion during cardiac surgery: A systematic
Chengji Zhao1, Evaldas Girdauskas2, Jan W Schoones3
1Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands.
Insights
Prophylactic left atrial appendage occlusion (LAAO) significantly reduces early and all-time thromboembolic events in cardiac surgery patients. However, it may be associated with an increased risk of postoperative atrial fibrillation (POAF).
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Concomitant left atrial appendage occlusion (LAAO) is a novel prophylactic strategy for preventing thromboembolic events in patients undergoing cardiac surgery.
- The efficacy and safety of prophylactic LAAO in patients without a prior history of atrial fibrillation remain under investigation.
Purpose of the Study:
- To evaluate the efficacy of prophylactic left atrial appendage occlusion (LAAO) in reducing thromboembolic complications after cardiac surgery.
- To assess the association between prophylactic LAAO and the risk of postoperative atrial fibrillation (POAF).
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials and retrospective observational studies.
- Searched major databases including PubMed, Embase, Web of Science, Emcare, and Cochrane Library.
- Primary endpoints included postoperative thromboembolic complications and postoperative atrial fibrillation (POAF).
Main Results:
- Analysis of 7369 patients (3823 LAAO, 3546 no LAAO) from 3 RCTs and 7 observational studies.
- Prophylactic LAAO significantly reduced early thromboembolic events by 58% (RR 0.42; p=0.002) and all-time thromboembolic complications by 52% (HR 0.48; p=0.005).
- A trend towards a statistically non-significant increase in the risk of POAF was observed with LAAO (RR 1.15; p=0.051).
Conclusions:
- Prophylactic LAAO effectively reduces the risk of early and long-term thromboembolic events in patients undergoing cardiac surgery.
- The procedure may be associated with a potential increase in the risk of postoperative atrial fibrillation.
- Further research is warranted to fully elucidate the risk-benefit profile of prophylactic LAAO.
Background:
Recently, concomitant left atrial appendage occlusion (LAAO) has emerged as prophylactic treatment option for preventing thromboembolic events in patients undergoing cardiac surgery with no known history of atrial fibrillation. The efficacy of prophylactic LAAO remains unknown.
Methods:
PubMed, Embase, Web of Science, Emcare, and the Cochrane Library were searched for studies on prophylactic LAAO in patients undergoing cardiac surgery. The primary endpoints were postoperative thromboembolic complications and postoperative atrial fibrillation (POAF).
Results:
Three randomized trials and seven retrospective observational studies were included: in total, 7369 patients received either prophylactic LAAO (n = 3823) or no prophylactic LAAO (n = 3546) during their index cardiac surgery. Prophylactic LAAO reduced the risk of early thromboembolic events by 58 % (risk ratio: 0.42; 95 % confidence interval: 0.25 to 0.73; p = 0.002; I2 = 0 %) with an estimated absolute risk reduction of 0.8 %. On the other hand, a higher risk, albeit statistically not significant, of POAF was seen with LAAO (risk ratio: 1.15; 95 % confidence interval: 1.00 to 1.32; p = 0.051; I2 = 64 %). Prophylactic LAAO also reduced the risk of all-time thromboembolic complications by 52 % (hazards ratio: 0.48; 95 % CI: 0.29 to 0.80; p = 0.005; I2 = 41 %).
Conclusion:
Prophylactic LAAO was associated with a reduction in early and all-time thromboembolic events but demonstrated a potential relation to a higher risk of POAF.
