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Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion? | LitMetric

Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion?

Interact Cardiovasc Thorac Surg

Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK.

Published: February 2010

AI Article Synopsis

  • - The text discusses a review of 310 studies on whether patients with atrial fibrillation undergoing cardiac surgery should have their left atrial appendage (LAA) excluded, highlighting only 12 papers as the best evidence. - Among the five clinical trials evaluated, including one randomized controlled trial on around 1,400 patients, only one trial showed a clear benefit of LAA occlusion, while others had neutral or negative outcomes, including one that indicated an increased risk. - The authors suggest that the mixed results may stem from low success rates in achieving complete occlusion, with most studies reporting success rates of only 55-66%, indicating that LAA occlusion could be more harmful than beneficial.

Article Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Should patients undergoing cardiac surgery with atrial fibrillation (AF) have left atrial appendage (LAA) exclusion?' Altogether 310 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that despite finding five clinical trials including one randomised controlled trial, that studied around 1400 patients who underwent LAA occlusion, the results of these studies do not clearly show a benefit for appendage occlusion. Indeed of the five studies, only one showed a statistical benefit for LAA occlusion, with three giving neutral results and in fact one demonstrating a significantly increased risk. One reason for this may be the inability to achieve acceptably high rates of successful occlusion on echocardiography when attempting to perform this procedure. The highest success rate was only 93% but most studies reported only a 55-66% successful occlusion rate when attempting closure in a variety of methods including stapling, ligation and amputation. Currently, the evidence is insufficient to support LAA occlusion and may indeed cause harm especially if incomplete exclusion occurs.

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Source
http://dx.doi.org/10.1510/icvts.2009.227991DOI Listing

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