Abstract
Introduction:
Surgical left atrial appendage (LAA) closure is an option in patients undergoing cardiac surgery who have a history of atrial fibrillation. Despite multiple studies, it is not clear whether LAA closure during cardiac surgery results in improved outcomes.
Hypothesis:
We hypothesized that LAA closure is associated with significant decrease in risk of stroke and mortality.
Methods:
We conducted Pubmed, EMBASE and CENTRAL searches for studies comparing cardiac surgery alone or with concomitant LAA closure. Efficacy outcome was future risk of stroke. Safety outcomes were total mortality and postoperative bleeding.
Results:
A total of six studies with 3267 patients fulfilled the inclusion criteria. Primary surgeries were mitral valve surgeries in four studies and coronary artery bypass grafting in 2 studies. Successful LAA closure confirmed by trans-esophageal echocardiography was achieved in 97.8% of patients. Concomitant left atrial appendage closure was not associated with any significant difference in risk of future stroke (Odds ratio (OR) 0.61, 95% Confidence Interval (CI) 0.30 to 1.24, p=0.12) or recurrence of atrial fibrillation (OR 0.92, 95% CI 0.66 to 1.29, p=0.63). However, the combined procedure was associated with lower long-term mortality (OR 0.41, 95% CI 0.22 to 0.77, p=0.005) when compared to cardiac surgery alone.
Conclusions:
Concomitant left atrial appendage closure is a safe procedure but is not associated with a significant decrease in future risk of stroke. Patients with LAA closure had significantly lower mortality but this may be related to lower long term use of anticoagulants and bleeding events in this group. These findings need to be investigated further in large prospective studies.