Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke

This multicenter, randomized trial (LAAOS III) evaluated whether surgical occlusion of the left atrial appendage (LAA) during cardiac surgery reduces the risk of ischemic stroke or systemic embolism in patients with atrial fibrillation and elevated stroke risk (CHA₂DS₂-VASc ≥2). A total of 4780 participants undergoing cardiac surgery were assigned to LAA occlusion (n=2379) or no occlusion (n=2391) in addition to standard care, including oral anticoagulation. Over a mean follow-up of 3.8 years, stroke or embolism occurred in 4.8% of the occlusion group versus 7.0% in the control group (hazard ratio 0.67; P=0.001). The benefit was more pronounced after the first 30 days postoperatively. Occlusion methods included cut-and-sew, stapler closure, closure devices, or internal suturing, with no increase in perioperative complications or bleeding. The procedure provided additive stroke prevention without replacing anticoagulation. The authors conclude that concomitant LAA occlusion during cardiac surgery safely lowers embolic stroke risk in atrial fibrillation patients at high risk.

This multicenter, randomized trial (LAAOS III) evaluated whether surgical occlusion of the left atrial appendage (LAA) during cardiac surgery reduces the risk of ischemic stroke or systemic embolism in patients with atrial fibrillation and elevated stroke risk (CHA₂DS₂-VASc ≥2). A total of 4780 participants undergoing cardiac surgery were assigned to LAA occlusion (n=2379) or no occlusion (n=2391) in addition to standard care, including oral anticoagulation. Over a mean follow-up of 3.8 years, stroke or embolism occurred in 4.8% of the occlusion group versus 7.0% in the control group (hazard ratio 0.67; P=0.001). The benefit was more pronounced after the first 30 days postoperatively. Occlusion methods included cut-and-sew, stapler closure, closure devices, or internal suturing, with no increase in perioperative complications or bleeding. The procedure provided additive stroke prevention without replacing anticoagulation. The authors conclude that concomitant LAA occlusion during cardiac surgery safely lowers embolic stroke risk in atrial fibrillation patients at high risk.