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

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2025-03-23 DOI:10.1016/j.hrthm.2025.03.1975

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

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引用次数: 0

Abstract

Background: The clinical efficacy of surgical occlusion of the left atrial appendage in sinus rhythm patients receiving cardiac surgery remains controversial.

Objective: 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.

Methods: 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.

Results: 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, I² = 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).

Conclusions: 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.

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.