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Surgical left atrial appendage occlusion during cardiac surgery： A systematic review and meta-analysis

World Journal of Cardiology 2018年第11期10卷 242-249页

作者： Varunsiri Atti Mahesh Anantha-Narayanan Mohit K Turagam Scott Koerber Sunil Rao Juan FViles-Gonzalez Rakesh MSuri poonam velagapudi Dhanunjaya Lakkireddy David G Benditt Department of Medicine Michigan State University-Sparrow Hospital East Lansing MI 48912 United States Division of Cardiovascular diseases Department of Medicine University of Minnesota Minneapolis MN 55455 United States Helmsley Electrophysiology Center Icahn School of medicine at Mount Sinai New York City NY 10029 United States Department of Cardiac Electrophysiology Medical University of South Carolina Charleston SC 29425 United States Department of Cardiovascular diseases Genesys Heart Institute Ascension Genesys Hospital Grand Blanc MI. Baptist Health South Florida Professor of Medicine at Wertheim College of Medicine Miami FL 33176. Cleveland Clinic Foundation and Cleveland Clinic Abu Dhabi Department of Thoracic and Cardiovascular Surgery. Cleveland Clinic Cleveland OH 44195 United States Structural Heart and Valve Center Center for Interventional Vascular Therapy Division of Cardiology Columbia University Medical Center New York City NY 10027 United States Kansas City Heart Rhythm Institute and Research Foundation Kansas City MO 64132 United States

AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO) during concomitant cardiac *** We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation(AF), reoperation for bleeding and postoperative complications. We further stratified the analysis based on propensity matched studies and AF *** Twelve studies(n = 40107) met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR: 0.63, 95%CI: 0.53-0.76; P < 0.001) and stroke(OR: 0.68, 95%CI: 0.57-0.82; P < 0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata. There was no significant difference in the incidence risk of allcause mortality, AF, and reoperation for bleeding and postoperative *** Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke, especially in those with AF without significant increase in adverse events. Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.

关键词： Left atrial appendage Left atrial appendageocclusion Embolic events Stroke Adverse events

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