title: Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis.
abstract: OBJECTIVE
  Concomitant left atrial appendage occlusion (LAAO) during surgical ablation has emerged as a potential treatment strategy to reduce stroke and perioperative mortality in patients with atrial fibrillation (AF). The present meta-analysis aims to assess current evidence on the efficacy and safety between LAAO and LAA preservation cohorts for patients undergoing cardiac surgery.
  
  
  METHODS
  Electronic searches were performed using six electronic databases from their inception to November 2013, identifying all relevant comparative randomized and observational studies comparing LAAO with non-LAAO in AF patients undergoing cardiac surgery. Data were extracted and analysed according to predefined endpoints including mortality, stroke, postoperative AF and reoperation for bleeding.
  
  
  RESULTS
  Seven relevant studies identified for qualitative and quantitative analyses, including 3653 patients undergoing LAAO (n = 1716) versus non-LAAO (n = 1937). Stroke incidence was significantly reduced in the LAAO occlusion group at the 30-day follow-up [0.95 vs 1.9%; odds ratio (OR) 0.46; P = 0.005] and the latest follow-up (1.4 vs 4.1%; OR 0.48; P = 0.01), compared with the non-LAAO group. Incidence of all-cause mortality was significantly decreased with LAAO (1.9 vs 5%; OR 0.38; P = 0.0003), while postoperative AF and reoperation for bleeding was comparable.
  
  
  CONCLUSIONS
  While acknowledging the limitations and inadequate statistical power of the available evidence, this study suggests LAAO as a promising strategy for stroke reduction perioperatively and at the short-term follow-up without a significant increase in complications. Larger randomized studies in the future are required, with clearer surgical and anticoagulation protocols and adequate long-term follow-up, to validate the clinical efficacy of LAAO versus non-LAAO groups.
authors: Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia.
authors: Yi-Chin
authors: YC
authors: Tsai
authors: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, Australia.
authors: Kevin
authors: K
authors: Phan
authors: Sydney Medical School, University of Sydney, Sydney, Australia Department of Cardiology, Hvidovre University Hospital, Copenhagen, Denmark.
authors: Stine
authors: S
authors: Munkholm-Larsen
authors: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors: David H
authors: DH
authors: Tian
authors: Department of Cardiothoracic Surgery and Cardiology, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands University Hospital Brussels, Brussels, Belgium.
authors: Mark
authors: M
authors: La Meir
authors: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia tristanyan@annalscts.com.
authors: Tristan D
authors: TD
authors: Yan
mesh_terms: D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects*; D006801:Humans; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
keywords: Atrial fibrillation; Left atrial appendage; Meta-analysis; Surgical occlusion