Abstract
Introduction: While percutaneous closure of left atrial appendage (LAA) can be a potential alternative to life-long anticoagulation in patients with atrial fibrillation (AF), comprehensive evidence on surgical LAA closure (LAAC) is scant. Hypothesis: Surgical LAAC is associated with reduced risk of mortality and stroke. Methods: We conducted a meta-analysis on the studies comparing the patients who underwent open-heart surgery with or without LAAC. Literature search was performed on PubMed, Embase, and Cochrane Trials databases. Outcomes of interest were 30-day/in-hospital mortality and morbidity, and late mortality and stroke. I-square statistics were used to evaluate heterogeneity and publication bias was evaluated by Begg’s and Egger’s tests. Results: We reviewed 821 articles and 12 articles including 7466 patients (3039 in LAAC group and 4427 in Non-LAAC group) were selected for the analysis. Among 12 studies, 3 were randomized-controlled, 2 were propensity-matched, and others were cohort study. There was no significant heterogeneity or publication bias. At 30-day/in-hospital follow-up, LAAC was not associated with risk of mortality or stroke (Risk ratio (RR) 0.67, 95% confidence interval (CI) 0.42-1.06 for mortality, and RR 0.83, 95%CI 0.54-1.26 for stroke). LAAC was not associated with risk of postoperative AF or re-exploration for bleeding. At the latest follow-up, LAAC was significantly associated with decreased risk of mortality (Risk ratio (RR) 0.64, 95%CI 0.44-0.94, p-value 0.024). This association showed similar tendency in stratified meta-analysis by age, sex, study design, type of surgery, and preoperative AF status. Conclusions: LAAC was associated with decreased risk of late mortality, but not late stroke. Better survival in LAAC group would be based on baseline differences or postoperative anticoagulation management. Further prospective investigation is needed to clarify these findings.
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