Clinical impact of surgical left atrial appendage occlusion during cardiac surgery in patients in sinus rhythm: A meta-analysis

Background: The clinical efficacy of surgical occlusion of the left atrial appendage in patients with sinus rhythm undergoing cardiac surgery remains controversial. Objective: This meta-analysis aims to evaluate the impact of left atrial appendage occlusion (LAAO) on early and late outcomes in sinus rhythm patients undergoing cardiac surgery. Methods: Screened and selected studies were sourced from PubMed, Embase, and Web of Science databases, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Early clinical outcomes were pooled using odds ratio, and long-term outcomes were extracted from Kaplan-Meier curves to reconstruct individual time-to-event patient data and allow for proportional hazards regression. Bias-treated data were selected when available. Results: Six studies, comprising 2742 patients, were included from the initial 1431 reports. Pooling of data demonstrated no significant association between LAAO and the development of postoperative atrial fibrillation (odds ratio 1.157; 95% confidence interval [CI] 0.904–1.481; I² = 46%; P = .246). Reconstruction of Kaplan-Meier data revealed greater freedom from cerebrovascular events in the LAAO group than in the no-LAAO group (hazard ratio 0.482; 95% CI 0.361–0.643; P < .001). The LAAO group also demonstrated improved midterm survival (hazard ratio 0.701; 95% CI 0.554–0.886; P = .003). Conclusion: This meta-analysis has demonstrated an improved freedom from cerebrovascular events and a midterm survival benefit in sinus rhythm patients undergoing cardiac surgery and surgical LAAO. This meta-analysis does not demonstrate an increased occurrence of postoperative atrial fibrillation in the LAAO group. Larger randomized controlled trials, stratified by cardiac pathology, are required to validate these findings.