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.
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.
Healey
Jeff S
JS
McMaster University, Hamilton, Ontario, Canada. healeyj@hhsc.ca
Crystal
Eugene
E
Lamy
Andre
A
Teoh
Kevin
K
Semelhago
Lloyd
L
Hohnloser
Stefan H
SH
Cybulsky
Irene
I
Abouzahr
Labib
L
Sawchuck
Corey
C
Carroll
Sandra
S
Morillo
Carlos
C
Kleine
Peter
P
Chu
Victor
V
Lonn
Eva
E
Connolly
Stuart J
SJ
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