The risk of ischemic stroke or systemic embolism was lower in patients with atrial fibrillation who left an atrial appendage obstruction during heart surgery compared to patients who did not, authors of a multicenter randomized study published in the New England report Journal of Medicine was published.
In particular, surgical occlusion of the left atrial appendage during heart surgery may be performed for other reasons, according to the authors, who wrote that while the procedure was adopted to prevent ischemic stroke in patients with atrial fibrillation, it has not been proven.
Investigators included adult participants in the Left Atrial Appendage Occlusion Study III (LAAOS III; ClinicalTrials.gov Identifier: NCT01561651) with a history of atrial fibrillation and a CHA2DS2-VASc score of at least 2 (on a scale of 0 to 9) exhibited. with higher scores indicating a higher risk) and should have heart surgery for another indication.
Participants were randomized 1: 1 to undergo or not to undergo left atrial appendage occlusion during surgery. All participants were expected to receive their usual care and most received oral anticoagulation therapy during follow-up visits, which occurred 30 days and then every 6 months after the procedure, with the last visit being on January 28, 2021 when one occurred ischemic stroke (including a transient ischemic attack with positive imaging) or systemic embolism.
There were 2,379 participants in the occlusion group and 2,391 in the non-occlusion group. The mean age was 71 years, 67.5% of the participants were men, and the mean CHA2DS2-VASc score was 4.2. Investigators followed 97.9% of the participants for an average of 3.8 years. In the occlusion group, 4.8% had a stroke or systemic embolism compared to 7.0% in the group without occlusion (hazard ratio [HR], 0.67; 95% CI, 0.53-0.85; P = .001). The incidence of perioperative bleeding, heart failure, and death did not differ significantly between the groups.
The LAAOS III study does not compare the effectiveness of the occlusion of the left atrial appendage with anticoagulation to reduce the risk of stroke and “therefore does not advocate simultaneous surgical occlusion as a substitute for oral anticoagulation,” emphasized the authors.
Disclosure: Some study authors stated links with biotech, pharmaceutical, and / or device companies. For a full list of the author’s disclosures, see the original reference.
Whitlock RP, Belley-Cote EP, Paparella D, et al. for the LAAOS III Investigators. Closure of the left atrial appendage during heart surgery to prevent a stroke. N Engl J Med. 2021; 384 (22): 2081-2091. doi: 10.1056 / NEJMoa2101897
This article originally appeared on The Cardiology Advisor