Title : Left atrial appendage occlusion during cardiac surgery to prevent stroke: A systematic review and meta-analysis
Abstract:
Introduction:
Atrial fibrillation accounts for one-sixth of all strokes, potentially leading to significant disability and death. The left atrial appendage (LAA) is the most common location for thrombus formation that can cause ischemic strokes. Excluding the LAA has been hypothesized to decrease the risk of ischemic strokes. This study examines LAA occlusion (LAAO) with otherwise indicated cardiac surgery and its effect on surgical outcomes.
Methods:
We followed the standards recommended by the Cochrane Collaborative Group and PRISMA checklist to prepare this systematic review and meta-analysis. Studies were retrieved through an online bibliographic search, studies were screened, and data were extracted. We compared the two study arms (LAAO and cardiac surgery without LAAO). Ten studies were included in this study.
Results:
LAAO is associated with significantly higher operative time (p<0.0001). There was no significant difference in all-cause mortality (p=0.98) and systemic embolism (p=0.31). There was a significantly lower risk of strokes (p< 0.0001) and, particularly, ischemic strokes (p =0.0007) in patients who underwent LAAO during their cardiac surgery.
Discussion:
LAAO can be done safely with other cardiac surgeries when performed concurrently. LAAO can complement the chemical anticoagulation regimen. Even with the limitations reported, LAAO is associated with a lower risk of stroke (and particularly ischemic strokes). Further studies are needed to shape guidance on the continuation versus discontinuation of chemical anticoagulation after LAAO, especially in the patients with a higher risk of bleeding.
Conclusion:
Current evidence supports LAAO during cardiac surgery. It significantly attenuates the risk for stroke events without significant change in operative time.
Audience Take Away:
- The audience will be able to use the evidence we are providing in their medical practice to achieve LAAO when patients are undergoing cardiac surgery
- Patients will benefit from having a low-risk, low-cost procedure to decrease their risk of stroke
- The faculty can use this research to conduct studies into the need for anti-coagulation after LAAO, and whether LAAO can replace anti-coagulation especially for high-risk population
- This research synthetizes evidence from current literature to guide medical care especially for patients who are at high risk of bleeding
