Left Atrial Appendage Occlusion During Cardiac Surgery to Prevent Stroke: A Systematic Review and Meta-Analysis.

Autor: Sayed A; Department of Medicine, Mercy Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: Alaa.a.sayed@outlook.com., Kamal A; Department of Medicine, Mercy Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Kamal I; Faculty of Medicine, Al-Azhar University, Cairo, Egypt., Fathallah AH; Faculty of Medicine, Minia University, Minia, Egypt., Nourelden AZ; Faculty of Medicine, Al-Azhar University, Cairo, Egypt., Zaidi SA; Department of Medicine, Mercy Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2024 Oct 29; Vol. 236, pp. 8-19. Date of Electronic Publication: 2024 Oct 29.
DOI: 10.1016/j.amjcard.2024.10.024
Abstrakt: Atrial fibrillation accounts for 1/6 of all strokes, potentially leading to significant disability and death. The left atrial appendage (LAA) is the primary location for thrombus formation. Excluding the LAA has been hypothesized to decrease the risk of ischemic stroke. This study examines LAA occlusion (LAAO) with otherwise indicated cardiac surgery and its effect on surgical outcomes. We followed the standards recommended by the Cochrane Collaborative Group and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (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 2 study arms (LAAO and cardiac surgery without LAAO). A total of 10 studies have been included in this study, and 6 randomized controlled trials were included in the meta-analysis, with data pooled from over 10,000 patients. LAAO is associated with no significant difference in the overall mortality (p = 0.98) and systemic embolism (p = 0.31). Strokes, particularly, ischemic strokes, have significantly lower risk in patients who underwent LAAO (p <0.0001 and p = 0.0007), respectively. In conclusion, LAAO can be done safely as a concomitant surgery with other cardiac surgeries, with a minimal incremental cost when performed concurrently. LAAO is associated with a lower risk of all stroke and ischemic strokes. Further studies are needed to shape guidance on the continuation versus discontinuation of anticoagulation after LAAO, especially in patient populations with a higher risk of bleeding.
Competing Interests: Declaration of competing interest The authors have no competing interests to declare.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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