窦性心律患者心脏手术中手术左心耳闭塞的临床影响：一项meta分析。

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2025-10-01 DOI:10.1016/j.hrthm.2025.03.1975

Samuel Burton MRes , Rayyan Ahmed , Nicola King PhD , Alexander Reynolds MRes , Amit Modi FRCS(CTh) , Sanjay Asopa FRCS(CTh)

{"title":"窦性心律患者心脏手术中手术左心耳闭塞的临床影响：一项meta分析。","authors":"Samuel Burton MRes , Rayyan Ahmed , Nicola King PhD , Alexander Reynolds MRes , Amit Modi FRCS(CTh) , Sanjay Asopa FRCS(CTh)","doi":"10.1016/j.hrthm.2025.03.1975","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The clinical efficacy of surgical occlusion of the left atrial appendage in patients with sinus rhythm undergoing cardiac surgery remains controversial.</div></div><div><h3>Objective</h3><div>This meta-analysis aims to evaluate the impact of left atrial appendage occlusion (LAAO) on early and late outcomes in sinus rhythm patients undergoing cardiac surgery.</div></div><div><h3>Methods</h3><div>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 using odds ratio, and long-term outcomes were extracted from Kaplan-Meier curves to reconstruct individual time-to-event patient data and allow for proportional hazards regression. Bias-treated data were selected when available.</div></div><div><h3>Results</h3><div>Six studies, comprising 2742 patients, were included from the initial 1431 reports. Pooling of data demonstrated no significant association between LAAO and the development of postoperative atrial fibrillation (odds ratio 1.157; 95% confidence interval [CI] 0.904–1.481; I<sup>2</sup> = 46%; <em>P</em> = .246). Reconstruction of Kaplan-Meier data revealed greater freedom from cerebrovascular events in the LAAO group than in the no-LAAO group (hazard ratio 0.482; 95% CI 0.361–0.643; <em>P</em> < .001). The LAAO group also demonstrated improved midterm survival (hazard ratio 0.701; 95% CI 0.554–0.886; <em>P</em> = .003).</div></div><div><h3>Conclusion</h3><div>This meta-analysis has demonstrated an improved freedom from cerebrovascular events and a midterm survival benefit in sinus rhythm patients undergoing cardiac surgery and surgical LAAO. This meta-analysis does not demonstrate an increased occurrence of postoperative atrial fibrillation in the LAAO group. Larger randomized controlled trials, stratified by cardiac pathology, are required to validate these findings.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2595-2602"},"PeriodicalIF":5.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical impact of surgical left atrial appendage occlusion during cardiac surgery in patients in sinus rhythm: A meta-analysis\",\"authors\":\"Samuel Burton MRes , Rayyan Ahmed , Nicola King PhD , Alexander Reynolds MRes , Amit Modi FRCS(CTh) , Sanjay Asopa FRCS(CTh)\",\"doi\":\"10.1016/j.hrthm.2025.03.1975\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The clinical efficacy of surgical occlusion of the left atrial appendage in patients with sinus rhythm undergoing cardiac surgery remains controversial.</div></div><div><h3>Objective</h3><div>This meta-analysis aims to evaluate the impact of left atrial appendage occlusion (LAAO) on early and late outcomes in sinus rhythm patients undergoing cardiac surgery.</div></div><div><h3>Methods</h3><div>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 using odds ratio, and long-term outcomes were extracted from Kaplan-Meier curves to reconstruct individual time-to-event patient data and allow for proportional hazards regression. Bias-treated data were selected when available.</div></div><div><h3>Results</h3><div>Six studies, comprising 2742 patients, were included from the initial 1431 reports. Pooling of data demonstrated no significant association between LAAO and the development of postoperative atrial fibrillation (odds ratio 1.157; 95% confidence interval [CI] 0.904–1.481; I<sup>2</sup> = 46%; <em>P</em> = .246). Reconstruction of Kaplan-Meier data revealed greater freedom from cerebrovascular events in the LAAO group than in the no-LAAO group (hazard ratio 0.482; 95% CI 0.361–0.643; <em>P</em> < .001). The LAAO group also demonstrated improved midterm survival (hazard ratio 0.701; 95% CI 0.554–0.886; <em>P</em> = .003).</div></div><div><h3>Conclusion</h3><div>This meta-analysis has demonstrated an improved freedom from cerebrovascular events and a midterm survival benefit in sinus rhythm patients undergoing cardiac surgery and surgical LAAO. This meta-analysis does not demonstrate an increased occurrence of postoperative atrial fibrillation in the LAAO group. Larger randomized controlled trials, stratified by cardiac pathology, are required to validate these findings.</div></div>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\"22 10\",\"pages\":\"Pages 2595-2602\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1547527125022374\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1547527125022374","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

摘要

背景：手术阻断左心耳治疗窦性心律患者的临床疗效仍有争议。目的：本荟萃分析试图证明左心耳闭塞（LAAO）对接受心脏手术的窦性心律患者早期和晚期预后的影响。方法：筛选和选择的研究来自PubMed、Embase和Web of Science数据库，遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目。早期临床结果通过优势比汇总，长期结果从Kaplan-Meier曲线中提取，以重建个体时间到事件的患者数据，并允许比例风险回归。在有偏倚处理的数据时选择。结果：从最初的1431份报告中纳入了6项研究，包括2742名患者。合并分析显示LAAO与术后房颤的发生无显著相关性（优势比（OR） 1.157, 95%可信区间（CI） 0.904-1.481, I2 = 46%, p = 0.246）。Kaplan Meier数据重建显示，与未LAAO组相比，LAAO组的脑血管事件自由度更高（危险比（HR） 0.482, 95%CI 0.361-0.643, p）。结论：对接受心脏手术和手术LAAO的窦性心律患者的分析显示，脑血管事件自由度得到改善，中期生存获益。该荟萃分析未显示LAAO研究组术后房颤发生率增加。需要按心脏病理分层进行更大规模的随机对照试验来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Clinical impact of surgical left atrial appendage occlusion during cardiac surgery in patients in sinus rhythm: A meta-analysis

Background

The clinical efficacy of surgical occlusion of the left atrial appendage in patients with sinus rhythm undergoing cardiac surgery remains controversial.

Objective

This meta-analysis aims to evaluate the impact of left atrial appendage occlusion (LAAO) on early and late outcomes in sinus rhythm patients 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 using odds ratio, and long-term outcomes were extracted from Kaplan-Meier curves to reconstruct individual time-to-event patient data and allow for proportional hazards regression. Bias-treated data were selected when available.

Results

Six studies, comprising 2742 patients, were included from the initial 1431 reports. Pooling of data demonstrated no significant association between LAAO and the development of postoperative atrial fibrillation (odds ratio 1.157; 95% confidence interval [CI] 0.904–1.481; I² = 46%; P = .246). Reconstruction of Kaplan-Meier data revealed greater freedom from cerebrovascular events in the LAAO group than in the no-LAAO group (hazard ratio 0.482; 95% CI 0.361–0.643; P < .001). The LAAO group also demonstrated improved midterm survival (hazard ratio 0.701; 95% CI 0.554–0.886; P = .003).

Conclusion

This meta-analysis has demonstrated an improved freedom from cerebrovascular events and a midterm survival benefit in sinus rhythm patients undergoing cardiac surgery and surgical LAAO. This meta-analysis does not demonstrate an increased occurrence of postoperative atrial fibrillation in the LAAO group. Larger randomized controlled trials, stratified by cardiac pathology, are required to validate these findings.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

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.