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Updated: Apr 2, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Surgical Left Atrial Appendage Occlusion During Cardiac Surgery in Atrial Fibrillation: A Contemporary Systematic
Abdul Rasheed Bahar1, Ishaq Khoury1, Mohamad Hamza2
1Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan.
Background:
Left atrial appendage occlusion (LAAO) has emerged as a promising adjunctive strategy for stroke prevention in patients with atrial fibrillation (AF) undergoing cardiac surgery. While previous studies have assessed its efficacy, a comprehensive evaluation integrating both randomized controlled trials and observational data remains limited.
Methods:
We conducted a systematic review and meta-analysis to evaluate the safety and effectiveness of LAAO compared with no LAAO in patients with AF undergoing cardiac surgery. A total of 20 studies (12 observational and 8 randomized controlled trials) encompassing 215,181 patients treated between 2005 and 2024 were included. Pooled odds ratios with 95% CIs were calculated using fixed- and random-effects models for primary and secondary outcomes, with heterogeneity, publication bias, and sensitivity analyses performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results:
Left atrial appendage occlusion was associated with a significant reduction in ischemic stroke (odds ratio, 0.72; 95% CI, 0.66-0.79), systemic embolism, hemorrhagic stroke, silent cerebral infarcts, and cardiac death. A significant reduction in all-cause mortality was observed using a fixed-effects model, but not with the random-effects model due to substantial heterogeneity. No significant differences were observed in myocardial infarction, peripheral ischemia, or major bleeding events. Sensitivity and cumulative analyses supported the robustness of the ischemic stroke findings. Subgroup analyses revealed no significant variation in outcomes based on study design or publication year.
Conclusions:
Left atrial appendage occlusion during cardiac surgery is associated with a significant reduction in thromboembolic events, without increasing the risk of major complications. These findings support the role of LAAO as a safe and effective adjunctive intervention in appropriately selected patients with AF. Further high-quality, prospective studies are warranted to confirm these benefits and inform guideline-directed practice.
