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Reconstructed Patient-Level Meta-analysis of Prophylactic Left Atrial Appendage Closure During Cardiac Surgery.

Andy Dong1, Grace Lee2, Vikram Krishna1

  • 1Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

The Canadian Journal of Cardiology
|December 12, 2025
PubMed
Summary
This summary is machine-generated.

Prophylactic left atrial appendage closure (LAAC) in cardiac surgery patients without atrial fibrillation significantly reduces stroke risk. This procedure offers a promising strategy for stroke prevention in this population.

Keywords:
atrial fibrillationleft atrial appendagestroke

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Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Preventive Medicine

Background:

  • The efficacy of prophylactic left atrial appendage closure (LAAC) in patients undergoing cardiac surgery without a history of atrial fibrillation remains uncertain.
  • Evaluating LAAC's potential to mitigate late stroke risk in this specific patient group is crucial.

Purpose of the Study:

  • To assess whether concomitant LAAC in cardiac surgery patients without preoperative atrial fibrillation lowers the incidence of late stroke.
  • To provide evidence-based insights into the prophylactic use of LAAC.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials and observational studies were conducted up to July 2025.
  • Individual patient data were reconstructed from digitized Kaplan-Meier curves to analyze stroke risk at 5 years.
  • Included studies compared LAAC versus no LAAC in cardiac surgery patients without atrial fibrillation.

Main Results:

  • The analysis included 4,306 patients who underwent LAAC and 4,129 who did not, with similar baseline characteristics.
  • While postoperative atrial fibrillation rates were higher with LAAC (31.1% vs 26.1%), 5-year freedom from stroke significantly improved (95.9% vs 94.4%, HR: 0.66).
  • The number needed to treat with LAAC to prevent one stroke was 67.

Conclusions:

  • Prophylactic LAAC in patients without atrial fibrillation undergoing cardiac surgery is associated with a reduced risk of stroke.
  • These findings suggest LAAC as a potential stroke-preventive measure in this population.
  • Further validation through large, multicenter randomized clinical trials is warranted.