Impact of Preoperative Cardiac Computed Tomography Angiography on Left Atrial Appendage Closure: A Systematic Review and Meta-Analysis.

Objective: Our aim is to evaluate the impact of preoperative cardiac CT on LAAC.

Methods: This research followed the protocols outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist, and it adhered to the previously described established methodologies. A search strategy was designed to utilize PubMed, EMBASE, Cochrane Library, and Web of Science for studies showing the effect of preoperative CCTA on LAAC from December 08, 2017, to June 12, 2023. For continuous outcome variables, the weighted mean difference (WMD) was used to estimate the effect size, whereas the odds ratio (OR) was used for dichotomous outcomes. We performed meta-regression to explore the heterogeneity among the included studies.

Results: Eight cohort studies (including one published only as an abstract) that evaluated the impact of preoperative CCTA for LAAC were identified and included in this meta-analysis. Compared with the CCTA negative group, patients in the CCTA positive group experienced a significantly shorter LAAC procedure time (WMD: -0.69; 95% CI: -1.11 to -0.28; P=0.00; I²=95.39%). In contrast, there were no significant differences in implantation success (OR: 1.04; 95% CI: 0.98-1.11; P=0.18; I²=45.61%), contrast volume (WMD: -0.07; 95% CI: -0.28 to 0.14; P=0.51; I²=77.38%), peri-device leak (OR: 0.56; 95% CI: 0.29-1.11; P=0.10; I²=87.33%), device-related thrombus (OR: 0.70; 95% CI: 0.36-1.35; P=0.29; I²=0%), pericardial effusion requiring intervention (OR: 1.09; 95% CI: 0.95-1.25; P=0.21; I²=0%), major adverse events (OR: 0.99; 95% CI: 0.89-1.09; P=0.78; I²=0%), and all-cause mortality (OR: 0.79; 95% CI: 0.54-1.16; P= 0.23; I²=0%).

Conclusions: Preoperative CCTA is associated with a shorter procedure time, but other parameters did not differ significantly between patients who underwent preoperative CCTA and those who did not.