title: Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke.
abstract: OBJECTIVE
  This pilot study assessed the safety and efficacy of left atrial appendage (LAA) occlusion, performed at the time of coronary artery bypass grafting (CABG).
  
  
  RESULTS
  At the time of CABG, 77 patients with risk factors for stroke were randomized to LAA occlusion or control. The LAA was occluded using sutures or a stapling device. Completeness of occlusion was assessed with transesophageal echocardiography. There were no significant differences in cardiopulmonary bypass duration, perioperative heart failure, atrial fibrillation, or bleeding between the 2 groups. During surgery, there were 9 appendage tears, all of which were repaired easily with sutures. Among patients having a postoperative transesophageal echocardiography, complete occlusion of the LAA was achieved in 45% (5/11) of cases using sutures and in 72% (24/33) using a stapler, P = .14. The rate of LAA occlusion by individual surgeons increased from 43% (9/21) to 87% (20/23) after performing 4 cases (P = .0001). After a mean follow-up of 13 +/- 7 months, 2.6% of patients had thromboembolic events.
  
  
  CONCLUSIONS
  LAA occlusion at the time of CABG is safe. The rate of complete occlusion improves, to acceptable levels, with increased experience and the use of a stapling device. A large trial is needed to determine if LAA occlusion prevents stroke.
authors.affiliation: McMaster University, Hamilton, Ontario, Canada. healeyj@hhsc.ca
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Healey
authors.forename: Eugene
authors.initials: E
authors.lastname: Crystal
authors.forename: Andre
authors.initials: A
authors.lastname: Lamy
authors.forename: Kevin
authors.initials: K
authors.lastname: Teoh
authors.forename: Lloyd
authors.initials: L
authors.lastname: Semelhago
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
authors.forename: Irene
authors.initials: I
authors.lastname: Cybulsky
authors.forename: Labib
authors.initials: L
authors.lastname: Abouzahr
authors.forename: Corey
authors.initials: C
authors.lastname: Sawchuck
authors.forename: Sandra
authors.initials: S
authors.lastname: Carroll
authors.forename: Carlos
authors.initials: C
authors.lastname: Morillo
authors.forename: Peter
authors.initials: P
authors.lastname: Kleine
authors.forename: Victor
authors.initials: V
authors.lastname: Chu
authors.forename: Eva
authors.initials: E
authors.lastname: Lonn
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000453:epidemiology; D008026:Ligation; D008297:Male; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012307:Risk Factors; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome