Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke
Abstract
Aim This pilot study assessed the safety and efficacy of left atrial appendage (LAA) occlusion, performed at the time of coronary artery bypass grafting (CABG).Methods and results At the time of CABG, 77 patients with risk factors for stroke were randomized to LAA occlusion or control. The LAA was occluded using sutures or a stapling device. Completeness of occlusion was assessed with transesophageal echocardiography. There were no significant differences in cardiopulmonary bypass duration, perioperative heart failure, atrial fibrillation, or bleeding between the 2 groups. During surgery, there were 9 appendage tears, all of which were repaired easily with sutures. Among patients having a postoperative transesophageal echocardiography, complete occlusion of the LAA was achieved in 45% (5/11) of cases using sutures and in 72% (24/33) using a stapler, P = .14. The rate of LAA occlusion by individual surgeons increased from 43% (9/21) to 87% (20/23) after performing 4 cases (P = .0001). After a mean follow-up of 13 +/- 7 months, 2.6% of patients had thromboembolic events.Conclusions LAA occlusion at the time of CABG is safe. The rate of complete occlusion improves, to acceptable levels, with increased experience and the use of a stapling device. A large trial is needed to determine if LAA occlusion prevents stroke.
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Multiple observational studies indicate the feasibility and safety of surgical LAA occlusion/exclusion, but only limited controlled trial data are available.
“Multiple observational studies indicate the feasibility and safety of surgical LAA occlusion/exclusion, but only limited controlled trial data are available.[461][462][463][464]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [462]
Cites
Atrial fibrillation as an independent risk factor for stroke: the Framingham study
Wolf, P. A., Abbott, R. D., & Kannel, W. B. (1991) · Stroke · doi:10.1161/01.str.22.8.983 · Cited by 7,388 · see citing works
Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation
Blackshear, J. L., & Odell, J. A. (1996) · The Annals of Thoracic Surgery · doi:10.1016/0003-4975(95)00887-x · Cited by 1,686 · see citing works
Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation
Hart, R. G., Benavente, O., McBride, R., & Pearce, L. A. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-131-7-199910050-00003 · Cited by 1,638 · see citing works
Primary Prevention of Ischemic Stroke
Goldstein, L. B., Adams, R. J., Becker, K. J., Furberg, C. D., Gorelick, P. B., Hádemenos, G. J., Hill, M., Howard, G., Howard, V. J., Jacobs, B. S., et al. (2001) · Stroke · doi:10.1161/01.str.32.1.280 · Cited by 897 · see citing works
Left atrial appendage: structure, function, and role in thromboembolism
Al-Saady, N. M., OBEL, O. A., & Camm, A. J. (1999) · Heart · doi:10.1136/hrt.82.5.547 · Cited by 686 · see citing works
Katz, E. S., Tsiamtsiouris, T., Applebaum, R. M., Schwartzbard, A. Z., Tunick, P. A., & Kronzon, I. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00765-8 · Cited by 392 · see citing works
Fernández, M. Á. G., David, E. P., Quiles, J., Peralta, J. P., García-Rojas, I., Bermejo, J., Moreno, M., & Silva, J. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00954-9 · Cited by 327 · see citing works
Jones, W., Williams, L. S., & Meschia, J. F. (2001) · Stroke · doi:10.1161/hs1001.096191 · Cited by 214 · see citing works
Blackshear, J. L., Johnson, W. D., Odell, J. A., Baker, V. S., Howard, M., Pearce, L. A., Stone, C. D., Packer, D. L., & Schaff, H. V. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00953-7 · Cited by 161 · see citing works
Connolly, S. J., Cybulsky, I. J., Lamy, A. L., et al. (2003) · American Heart Journal · doi:10.1067/mhj.2003.147 · Cited by 157 · see citing works
Self-citationYoshihara, F., Nishikimi, T., Kosakai, Y., Isobe, F., Matsuoka, H., Takishita, S., Kawashima, Y., Saito, Y., Matsuo, H., & Kangawa, K. (1998) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(98)70119-9 · Cited by 80 · see citing works
Crystal, E., Lamy, A. L., Connolly, S. J., Kleine, P., Hohnloser, S. H., Semelhago, L., Abouzhar, L., Cybulsky, I. J., Shragge, B. W., Teoh, K., et al. (2003) · American Heart Journal · doi:10.1067/mhj.2003.44 · Cited by 75 · see citing works
Self-citationYoshihara, F., Nishikimi, T., Sasako, Y., Kobayashi, J., Kosakai, Y., Hattori, R., Horio, T., Kitamura, S., Matsuo, H., Ohe, T., et al. (2000) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(00)70015-8 · Cited by 24 · see citing works
Juratil, N. M., Wilkoff, B. L., TCHOU, P. J., et al. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)80364-3 · Cited by 6 · see citing works
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
Self-citation2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177292 · Cited by 2,805 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
Self-citation2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933 · see citing works
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Kay, G. N., Le Huezey, J.-Y., Lowe, J. E., et al. (2011) · Circulation · doi:10.1161/cir.0b013e318214876d · Cited by 859 · see citing works
Khairy, P., Van Hare, G. F., Balaji, S., Berul, C. I., Cecchin, F., Cohen, M. I., Daniels, C. J., Deal, B. J., Dearani, J. A., Groot, N. D., et al. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.05.009 · Cited by 709 · see citing works
Aryana, A., Singh, S. K., Singh, S. M., Gearoid O’Neill, P., Bowers, M. R., Allen, S. L., Lewandowski, S. L., Vierra, E. C., & d’Avila, A. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.028 · Cited by 184 · see citing works
Tsai, Y.-C., Phan, K., Munkholm-Larsen, S., Tian, D. H., La Meir, M., & Yan, T. D. (2015) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezu291 · Cited by 167 · see citing works
Left atrial appendage clip occlusion: early clinical results
Salzberg, S. P., Plass, A., Emmert, M. Y., Desbiolles, L., Alkadhi, H., Grünenfelder, J., & Genoni, M. (2010) · The Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2009.06.033 · Cited by 134 · see citing works
- Authors
- Healey, J. S., Crystal, E., Lamy, A., Teoh, K., Semelhago, L., Hohnloser, S. H., Cybulsky, I., Abouzahr, L., Sawchuck, C., Carroll, S., Morillo, C., Kleine, P., Chu, V., Lonn, E., & Connolly, S. J.
- Affiliations
- McMaster University (CA)
- University of Toronto (CA)
- Goethe University Frankfurt (DE)
- Corresponding author
- Healey, Jeff S.
- ORCID
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2005-08
- Volume
- 150
- Issue
- 2
- Pages
- 288-293
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2125485617
- Cited by
- 496
- References
- 14
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 19 · 2023: 24 · 2022: 21 · 2021: 22 · 2020: 22 · 2019: 20 · 2018: 28 · 2017: 38 · 2016: 35 · 2015: 43 · 2014: 31 · 2013: 32 · 2012: 30
- FWCI
- 7.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- left atrial appendage closure, coronary artery bypass grafting, stroke prevention, thromboembolism, surgical stapler, transesophageal echocardiography, perioperative atrial fibrillation
- MeSH terms
- Aged, Coronary Artery Bypass, Atrial Fibrillation, Brain Ischemia, Coronary Disease, Female, Heart Failure, Humans, Hypertension, Intraoperative Complications, Ligation, Male, Pilot Projects, Postoperative Complications, Risk Factors, Suture Techniques, Treatment Outcome, Echocardiography, Transesophageal, Surgical Stapling, Postoperative Hemorrhage, Atrial Appendage, Intracranial Embolism
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