Surgical left atrial appendage occlusion during cardiac surgery: A systematic review and meta-analysis

Table 1 Characteristics of the included studies

Study, yr	Country	Study period	Study design	Sample size		Cardiac surgery type	Follow up period (mo)
				s-LAAO	No occlusion
García-Fernández et al, 2003[3]	Spain	2003	retrospective	58	147	MVS	69.4 ± 67
Healey et al, 2005[7]	Germany	2001-2002	RCT	52	25	CABG	13 ± 7
Nagpal et al, 2009[8]	Canada	2007-2007	RCT	22	21	MVS	<1
Whitlock et al, 2013[9]	Canada	2009-2010	RCT	26	25	CABG and VS	1
Zapolanski et al, 2013[4]	United States	2005-2012	retrospective	808	969	CABG and VS	NR
Kim et al, 2013[6]	United States	2001-2010	retrospective	631	631	CABG and MVS	1
Lee et al, 20141[5]	Korea	1999-2011	retrospective	119	119	MVS with AF ablation	63 ± 44
Melduni et al, 20171[10]	United States	2000-2005	prospective	461	461	CABG and VS	109.2
Elbadawi et al, 20172[11]	United States	1998-2013	retrospective	652	652	VS	In-hospital
Elbadawi et al, 2017[12]	United States	2004-2013	retrospective	2519	12595	CABG	In-hospital
Friedman et al, 2018[14]	United States	2011-2012	retrospective	3892	6632	CABG, MVS, AVS	31.2
Yao et al, 20181[13]	United States	2009-2017	retrospective	4295	4295	CABG, VS	25.2 ± 22.8

RCT: Randomized controlled trial; CABG: Coronary artery bypass grafting; VS: Valvular surgery; MVS: Mitral valve surgery; AVS: Aortic valve surgery; AF: Atrial fibrillation. ¹Propensity match studies. ²Case matching study.

Table 2 Baseline and procedural characteristics of included studies

Study	Age (mean ± SD)		Hypertension		AF (%)		Technique of s-LAAO
	s-LAAO	No occlusion	s-LAAO	No occlusion	s-LAAO	No occlusion
García-Fernández et al, 2003[3]	63 ± 12	62 ± 10	NR	NR	NR		Double suturing
Healey et al, 2005[7]	72 ± 6	71 ± 5	75	92	17	8	Suture or stapler
Nagpal et al, 2009[8]	57.8 ± 13.3	59.2 ± 11.9	NR	NR	18	29	Resection
Whitlock et al, 2013[9]	77.4 ± 6.8	74.6 ± 7.6	92.3	92	100	100	Amputation and closure or stapler
Zapolanski et al, 2013[4]	70.52 ± 11.83		83.9	80.6	19.9	10.7	Double ligation
Kim et al, 2013[6]	66.6 ± 11.4	65.8 ± 11.6	80.9	73.1	NR	NR	Ligation and excision
Lee et al, 2014[5]	55.9 ± 12.2	50.7 ± 12.4	19.8	14.5	100	100	Amputation
Melduni et al, 2017[10]	67.4 ± 12.7	67.6 ± 13.5	59	61	47	45	Amputation, suturing or stapler
Elbadawi et al, 2017[11]	70.8 ± 10.2	71.2 ± 11.1	70.6	52.8	100	100	NR
Elbadawi et al, 2017[12]	71.3 ± 9	70.6 ± 8.7	78.5	76.1	100	100	NR
Friedman et al, 2018[14]	75 ± 5.9	76.4 ± 6.4	14.5	12.7	50.5	43.4	Any technique
Yao et al, 2018[13]	68.2 ± 10.6	65.8 ± 11.3	88.6	90.4	75.4	31.4

Table 3 Complications reported in the individual studies

Study	Total complications	Type of complications
	s-LAAO (%) vs No occlusion (%)	s-LAAO	No occlusion
Healey et al, 2005[7]	8 (52) vs 1 (4)	8- intraoperative LAA tears	1- LAA tear
Nagpal et al, 2009[8]	14 (63.6) vs 11 (52.3)	1- septicemia 1- myocardial infarction 2- RBC transfusion 8- temporary pacemaker 2- permanent pacemaker	1- RBC transfusion 7- temporary pacemaker 3- permanent pacemaker
Whitlock et al, 2013[9]	1 (3.8) vs 2 (25)	1- major bleeding	2- major bleeding
Zapolonski et al, 2013[4]	3 (0.3) vs 5 (0.6)	3- myocardial infarction	5- myocardial infarction
Lee et al, 2014[5]	22 (18.4) vs 22 (18.4)	9- requirement of dialysis 4- permanent pacemaker insertion 1- wound revision 8- pericardial effusion	1- low cardiac output syndrome 10- dialysis 2- permanent pacemaker insertion 1- mediastinitis 2- wound revision 6- pericardial effusion
Melduni et al, 2017[10]	32 (6.9) vs 32 (6.9)	14- pneumonia 18- acute renal failure	14- pneumonia 18- acute renal failure
Elbadawi et al, 2017[11]	17 (3.1) vs 9 (1.6)	17- pericardial effusion	7- pericardial effusion 2- hemorrhage
Elbadawi et al, 2017[12]	1030 (40.8) vs 2903 (23)	16- cardiac tamponade 68- pericardial effusion 917- hemorrhage 29- postoperative shock	19- cardiac tamponade 151- pericardial effusion 2687- hemorrhage 46- postoperative shock

RBC: Red blood cell; LAA: Left atrial appendage.