Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2018; 10(11): 242-249
Published online Nov 26, 2018. doi: 10.4330/wjc.v10.i11.242
Surgical left atrial appendage occlusion during cardiac surgery: A systematic review and meta-analysis
Varunsiri Atti, Mahesh Anantha-Narayanan, Mohit K Turagam, Scott Koerber, Sunil Rao, Juan F Viles-Gonzalez, Rakesh M Suri, Poonam Velagapudi, Dhanunjaya Lakkireddy, David G Benditt
Varunsiri Atti, Department of Medicine, Michigan State University-Sparrow Hospital, East Lansing, MI 48912, United States
Mahesh Anantha-Narayanan, David G Benditt, Division of Cardiovascular diseases, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
Mohit K Turagam, Helmsley Electrophysiology Center, Icahn School of medicine at Mount Sinai, New York City, NY 10029, United States
Scott Koerber, Department of Cardiac Electrophysiology, Medical University of South Carolina, Charleston, SC 29425, United States
Sunil Rao, Department of Cardiovascular diseases, Genesys Heart Institute, Ascension Genesys Hospital, Grand Blanc, MI.
Juan F Viles-Gonzalez, Baptist Health South Florida, Professor of Medicine at Wertheim College of Medicine, Miami, FL 33176.
Rakesh M Suri, Cleveland Clinic Foundation and Cleveland Clinic Abu Dhabi, Department of Thoracic and Cardiovascular Surgery. Cleveland Clinic, Cleveland, OH 44195, United States
Poonam Velagapudi, Structural Heart and Valve Center, Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center, New York City, NY 10027, United States
Dhanunjaya Lakkireddy, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, MO 64132, United States
Supported by no external funding. Dr. Benditt is supported in part by a grant from the Dr. Earl E Bakken family in support of heart-brain research.
Author contributions: Atti V, Anantha-Narayanan M contributed equally to this work and performed the analysis. Turagam MK designed the research. Koerber S, Rao S, Viles-Gonzalez JF, Suri R, Velagapudi P, Lakkireddy D and Benditt DG supervised the research. All the authors had role in writing the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Mahesh Anantha-Narayanan, MD, Academic Fellow, Doctor, Division of Cardiovascular Diseases, Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States. manantha@umn.edu
Telephone: +1-612-6262451 Fax: +1-612-6264411
Received: August 9, 2018
Peer-review started: August 9, 2018
First decision: August 24, 2018
Revised: September 8, 2018
Accepted: October 12, 2018
Article in press: October 12, 2018
Published online: November 26, 2018
Processing time: 109 Days and 0.5 Hours
Abstract
AIM

To evaluate the safety and efficacy of surgical left atrial appendage occlusion (s-LAAO) during concomitant cardiac surgery.

METHODS

We performed a comprehensive literature search through May 31st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation (AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF predominance.

RESULTS

Twelve studies (n = 40107) met the inclusion criteria. s-LAAO was associated with lower risk of embolic events (OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke (OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001). Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of all-cause mortality, AF, and reoperation for bleeding and postoperative complications.

CONCLUSION

Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.

Keywords: Left atrial appendage; Left atrial appendage occlusion; Embolic events; Stroke; Adverse events

Core tip: Surgical left atrial appendage occlusion (s-LAAO) is performed during cardiac surgeries in patients with atrial fibrillation. However, evidence to perform routinely during cardiac surgeries is conflicting and contrasting. It is currently given a class IIb recommendation in the professional medical society guidelines. We sought to perform a meta-analysis of all the studies published to date to evaluate the safety and efficacy of s-LAAO.