The Clinical Impact of Surgical Left Atrial Appendage Occlusion During Cardiac Surgery in Sinus Rhythm Patients: A Meta-Analysis.

Burton, Samuel; Ahmed, Rayyan; King, Nicola; Reynolds, Alexander; Modi, Amit; Asopa, Sanjay

Abstract

The clinical efficacy of surgical occlusion of the left atrial appendage in sinus rhythm patients receiving cardiac surgery remains controversial. This meta-analysis attempts to demonstrate the impact of left atrial appendage occlusion (LAAO) on early and late outcomes in patients with sinus rhythm undergoing cardiac surgery. Screened and selected studies were sourced from PubMed, Embase, and Web of Science databases, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Early clinical outcomes were pooled by odds ratio, and long-term outcomes were extracted from Kaplan-Meier curves to reconstruct individual time-to-event patient data and allow for proportional hazard regression. Bias-treated data was selected when available. Six studies, comprising 2742 patients, were included from an initial 1431 reports. Pooling demonstrated no significant association between LAAO and the development of postoperative atrial fibrillation (odds ratio (OR) 1.157, 95% confidence interval (CI) 0.904-1.481, I = 46%, p = 0.246). Reconstruction of Kaplan Meier data revealed a higher freedom from cerebrovascular events in the LAAO group than in no-LAAO (hazards ratio (HR) 0.482, 95%CI 0.361-0.643, p <0.001). The LAAO study group also demonstrated improved mid-term survival (HR 0.701, 95%CI 0.554-0.886, p=0.003). Analysis of patients in sinus rhythm undergoing cardiac surgery and receiving surgical LAAO has demonstrated improved freedom from cerebrovascular events and a mid-term survival benefit. This meta-analysis did not demonstrate an increased occurrence of postoperative atrial fibrillation in the LAAO study group. Larger randomised controlled trials stratified by cardiac pathology are required to validate these findings. [Abstract copyright: Copyright © 2025. Published by Elsevier Inc.]

Citation

Burton, S., Ahmed, R., King, N., Reynolds, A., Modi, A., & Asopa, S. (online). The Clinical Impact of Surgical Left Atrial Appendage Occlusion During Cardiac Surgery in Sinus Rhythm Patients: A Meta-Analysis. Heart Rhythm, https://doi.org/10.1016/j.hrthm.2025.03.1975

• Journal Article Type: Article
• Acceptance Date: Mar 19, 2025
• Online Publication Date: Mar 23, 2025
• Deposit Date: Apr 15, 2025
• Journal: Heart rhythm
• Print ISSN: 1547-5271
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.hrthm.2025.03.1975
• Keywords: Cardiac surgery, Sinus rhythm, Cerebrovascular events, Atrial fibrillation, Left atrial appendage occlusion
• Public URL: https://keele-repository.worktribe.com/output/1195377
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1547527125022374?via%3Dihub