Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke

This multicenter, randomized controlled trial (LAAOS III) assessed whether concomitant left atrial appendage occlusion (LAAO) during cardiac surgery reduces stroke or systemic embolism risk in patients with atrial fibrillation and CHA₂DS₂-VASc scores ≥2. A total of 4762 participants undergoing cardiac surgery for another indication were randomized to receive LAAO or not. Over a mean follow-up of 3.8 years, ischemic stroke or systemic embolism occurred in 4.8% of the LAAO group vs. 7.0% in the control group (HR: 0.67; 95% CI: 0.53–0.85; P=0.001). Most participants (~77% at 3 years) continued oral anticoagulation, indicating additive protective benefit of LAAO. No differences were found in perioperative bleeding, heart failure, or mortality. Subgroup analysis confirmed consistent benefit regardless of age, rhythm type, or baseline anticoagulation. Stroke reductions were most pronounced beyond the first 30 postoperative days. The study concludes that surgical LAAO performed during cardiac surgery effectively reduces thromboembolic events in high-risk atrial fibrillation patients receiving standard care

This multicenter, randomized controlled trial (LAAOS III) assessed whether concomitant left atrial appendage occlusion (LAAO) during cardiac surgery reduces stroke or systemic embolism risk in patients with atrial fibrillation and CHA₂DS₂-VASc scores ≥2. A total of 4762 participants undergoing cardiac surgery for another indication were randomized to receive LAAO or not. Over a mean follow-up of 3.8 years, ischemic stroke or systemic embolism occurred in 4.8% of the LAAO group vs. 7.0% in the control group (HR: 0.67; 95% CI: 0.53–0.85; P=0.001). Most participants (~77% at 3 years) continued oral anticoagulation, indicating additive protective benefit of LAAO. No differences were found in perioperative bleeding, heart failure, or mortality. Subgroup analysis confirmed consistent benefit regardless of age, rhythm type, or baseline anticoagulation. Stroke reductions were most pronounced beyond the first 30 postoperative days. The study concludes that surgical LAAO performed during cardiac surgery effectively reduces thromboembolic events in high-risk atrial fibrillation patients receiving standard care