Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis
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OBJECTIVES: Concomitant left atrial appendage occlusion (LAAO) during surgical ablation has emerged as a potential treatment strategy to reduce stroke and perioperative mortality in patients with atrial fibrillation (AF). The present meta-analysis aims to assess current evidence on the efficacy and safety between LAAO and LAA preservation cohorts for patients undergoing cardiac surgery. METHODS: Electronic searches were performed using six electronic databases from their inception to November 2013, identifying all relevant comparative randomized and observational studies comparing LAAO with non-LAAO in AF patients undergoing cardiac surgery. Data were extracted and analysed according to predefined endpoints including mortality, stroke, postoperative AF and reoperation for bleeding. RESULTS: Seven relevant studies identified for qualitative and quantitative analyses, including 3653 patients undergoing LAAO (n = 1716) versus non-LAAO (n = 1937). Stroke incidence was significantly reduced in the LAAO occlusion group at the 30-day follow-up [0.95 vs 1.9%; odds ratio (OR) 0.46; P = 0.005] and the latest follow-up (1.4 vs 4.1%; OR 0.48; P = 0.01), compared with the non-LAAO group. Incidence of all-cause mortality was significantly decreased with LAAO (1.9 vs 5%; OR 0.38; P = 0.0003), while postoperative AF and reoperation for bleeding was comparable. CONCLUSIONS: While acknowledging the limitations and inadequate statistical power of the available evidence, this study suggests LAAO as a promising strategy for stroke reduction perioperatively and at the short-term follow-up without a significant increase in complications. Larger randomized studies in the future are required, with clearer surgical and anticoagulation protocols and adequate long-term follow-up, to validate the clinical efficacy of LAAO versus non-LAAO groups.
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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 [463]
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Cites
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623 · see citing works
Fuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Kay, G. N., Huezey, J.-Y. L., Lowe, J. E., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.09.013 · Cited by 921 · see citing works
Safety of Percutaneous Left Atrial Appendage Closure
Reddy, V. Y., Holmes, D. R., Doshi, S. K., Neužil, P., & Kar, S. (2011) · Circulation · doi:10.1161/circulationaha.110.976449 · Cited by 863 · see citing works
Atrial Fibrillation after Cardiac Surgery
Maisel, W. H., Rawn, J. D., & Stevenson, W. G. (2001) · Annals of Internal Medicine · doi:10.7326/0003-4819-135-12-200112180-00010 · Cited by 801 · see citing works
Healey, J. S., Crystal, E., Lamy, A., Teoh, K., Semelhago, L., Hohnloser, S. H., Cybulsky, I., Abouzahr, L., Sawchuck, C., Carroll, S., et al. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.09.054 · Cited by 496 · 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
Prognostic implications of left artial spontaneous echo contrast in nonvalvular atrial fibrillation
Leung, D. Y., Black, I. W., Cranney, G. B., Hopkins, A. P., & Walsh, W. (1994) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)90025-6 · Cited by 365 · see citing works
Impact of the maze procedure on the stroke rate in patients with atrial fibrillation
Cox, J. L., Ad, N., & Palazzo, T. (1999) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(99)70052-8 · Cited by 356 · 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
Ngaage, D. L., Schaff, H. V., Mullany, C. J., Sundt, T. M., Dearani, J. A., Barnes, S. A., Daly, R. C., & Orszulak, T. A. (2006) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2006.09.021 · Cited by 155 · see citing works
Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III.
Whitlock, R. P., Healey, J. S., Vincent, J., Brady, K., Teoh, K., Royse, A. G., Shah, P. J., Guo, Y., Alings, M., Folkeringa, R., et al. (2014) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2225-319x.2013.12.06 · Cited by 144 · see citing works
Dawson, A. G., Asopa, S., & Dunning, J. (2009) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1510/icvts.2009.227991 · Cited by 133 · see citing works
Left Atrial Appendage Occlusion Study II (LAAOS II)
Whitlock, R. P., Vincent, J., Blackall, M. H., Hirsh, J., Fremes, S. E., Novick, R. J., Devereaux, P. J., Teoh, K., Lamy, A. L., Connolly, S. J., et al. (2013) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2013.06.015 · Cited by 121 · see citing works
Phan, K. H., Xie, A., Meir, M. L., Black, D. A., & Yan, T. D. (2014) · Heart · doi:10.1136/heartjnl-2013-305351 · Cited by 114 · see citing works
Self-citationLeft Atrial Appendage Occlusion: Lessons Learned From Surgical and Transcatheter Experiences
Chatterjee, S., Alexander, J. C., Pearson, P. J., & Feldman, T. E. (2011) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2011.08.044 · Cited by 91 · see citing works
Population rates of hospitalization for atrial fibrillation/flutter in Canada.
Humphries, K. H., Jackevicius, C. A., Gong, Y., Svensen, L., Cox, J. L., Tu, J. V., & Laupacis, A. (2004) · PubMed · Cited by 76 · see citing works
Phan, K. H., Xie, A., Tian, D. H., Shaikhrezai, K., & Yan, T. D. (2014) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2225-319x.2014.01.04 · Cited by 74 · see citing works
Self-citationKim, R., Baumgartner, N. E., & Clements, J. M. (2012) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2012.10.016 · Cited by 65 · see citing works
A systematic review of surgical ablation versus catheter ablation for atrial fibrillation.
Kearney, K. L., Stephenson, R. R., Phan, K. H., Chan, W. Y., Huang, M., & Yan, T. D. (2013) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2225-319x.2013.11.06 · Cited by 54 · see citing works
Self-citationLee, C.-H., Kim, J. B., Jung, S., Choo, S. J., Chung, C. H., & Lee, J. W. (2013) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2013.07.073 · Cited by 46 · see citing works
Nagpal, D., Torracca, L., Fumero, R., Denti, P., Cioni, M., & Alfieri, O. (2009) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2009.03.024 · Cited by 35 · see citing works
Zapolanski, A., Johnson, C. K., Dardashti, O., OʼKeefe, R., Rioux, N., Ferrari, G. M., Shaw, R. E., Brizzio, M. E., & Grau, J. B. (2013) · Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery · doi:10.1097/imi.0000000000000022 · Cited by 25 · see citing works
Roth, P., Rahimi, A., & Boening, A. (2010) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2010.04.043 · Cited by 17 · see citing works
Left Atrial Appendage Exclusion for Stroke Prevention in Atrial Fibrillation
Patel, T. K., Yancy, C. W., & Knight, B. P. (2012) · Cardiology Research and Practice · doi:10.1155/2012/610827 · Cited by 16 · see citing works
Stroke prevention in atrial fibrillation: Warfarin faces its challengers
Blackshear, J. L., & Kusumoto, F. M. (2005) · Current Cardiology Reports · doi:10.1007/s11886-005-0005-7 · Cited by 6 · see citing works
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Research works printed but not linked: 1
- Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008-12.
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Sorted by citations
2018 ESC/EACTS guidelines on myocardial revascularization
Neumann, F.-J., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A. P., Benedetto, U., Byrne, R. A., Collet, J.-P., Falk, V., Head, S. J., et al. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehy394 · Cited by 7,167 · 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 Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2021 ESC/EACTS Guidelines for the management of valvular heart disease
Vahanian, A., Beyersdorf, F., Praz, F., Milojevic, M., Baldus, S., Bauersachs, J., Capodanno, D., Conradi, L., De Bonis, M., De Paulis, R., et al. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehab395 · Cited by 5,685 · 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
Phan, K., Ha, H. S. K., Phan, S., Medi, C., Thomas, S. P., & Yan, T. D. (2015) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezu551 · Cited by 143 · see citing works
Self-citation
- Authors
- Tsai, Y.-C., Phan, K., Munkholm-Larsen, S., Tian, D. H., La Meir, M., & Yan, T. D.
- Affiliations
- Prince Charles Hospital (AU)
- The University of Sydney (AU)
- Collaborative Research Group (AU)
- Corresponding author
- Yan, Tristan D.
- Venue
- European Journal of Cardio-Thoracic Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-07-26
- Volume
- 47
- Issue
- 5
- Pages
- 847-854
- ISSN
- 1010-7940 (ISSN-L)
- 1873-734X
- OpenAlex
- W2099588187
- Cited by
- 167
- References
- 25
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 11 · 2023: 9 · 2022: 12 · 2021: 17 · 2020: 15 · 2019: 17 · 2018: 31 · 2017: 20 · 2016: 10 · 2015: 8 · 2014: 1
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Cardio-Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- left atrial appendage closure, atrial fibrillation, cardiac surgery, stroke prevention, perioperative mortality, postoperative atrial fibrillation, reoperation for bleeding, anticoagulation
- MeSH terms
- Atrial Fibrillation, Cardiac Surgical Procedures, Humans, Catheter Ablation, Atrial Appendage, Stroke
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