Left Atrial Appendage Occlusion Study (LAAOS)
Left Atrial Appendage Occlusion Study (LAAOS)
Aim: This pilot study assessed the safety and efficacy of left atrial appendage (LAA) occlusion, performed at the time of coronary artery bypass grafting (CABG).
Methods and Results: At the time of CABG, 77 patients with risk factors for stroke were randomized to LAA occlusion or control. The LAA was occluded using sutures or a stapling device. Completeness of occlusion was assessed with transesophageal echocardiography. There were no significant differences in cardiopulmonary bypass duration, perioperative heart failure, atrial fibrillation, or bleeding between the 2 groups. During surgery, there were 9 appendage tears, all of which were repaired easily with sutures. Among patients having a postoperative transesophageal echocardiography, complete occlusion of the LAA was achieved in 45% (5/11) of cases using sutures and in 72% (24/33) using a stapler, P = .14. The rate of LAA occlusion by individual surgeons increased from 43% (9/21) to 87% (20/23) after performing 4 cases (P = .0001). After a mean follow-up of 13 ± 7 months, 2.6% of patients had thromboembolic events.
Conclusions: LAA occlusion at the time of CABG is safe. The rate of complete occlusion improves, to acceptable levels, with increased experience and the use of a stapling device. A large trial is needed to determine if LAA occlusion prevents stroke.
Atrial fibrillation (AF) is an important risk factor for stroke, and effective strategies for stroke prevention are needed. In the last 10 years, the use of oral anticoagulants in patients with AF has lead to a significant reduction in stroke. Still, stroke remains a major cause of serious disability and death in AF, and additional preventive strategies are needed. AF accounts for one sixth of all strokes, and up to 25% of strokes in patients aged >80 years. Many patients undergoing coronary artery bypass grafting (CABG) eventually develop AF and are at risk of AF-related stroke. Patients undergoing CABG aged >75 years, with a history of hypertension or with previous stroke, have risk factors for both AF and stroke. Approximately 90% of left atrial thrombi are found in the left atrial appendage (LAA), and thus surgical occlusion of this structure is an attractive method for potentially reducing stroke. In contrast to procedures for LAA occlusion done independently of other surgery, occlusion at the time of CABG may be done with little incremental time, cost, and risk. However, the safety and feasibility of LAA occlusion, at the time of CABG surgery, have never been evaluated in a randomized trial. This pilot study was conducted to assess the safety and feasibility of surgical LAA occlusion as a concomitant procedure to CABG.
Aim: This pilot study assessed the safety and efficacy of left atrial appendage (LAA) occlusion, performed at the time of coronary artery bypass grafting (CABG).
Methods and Results: At the time of CABG, 77 patients with risk factors for stroke were randomized to LAA occlusion or control. The LAA was occluded using sutures or a stapling device. Completeness of occlusion was assessed with transesophageal echocardiography. There were no significant differences in cardiopulmonary bypass duration, perioperative heart failure, atrial fibrillation, or bleeding between the 2 groups. During surgery, there were 9 appendage tears, all of which were repaired easily with sutures. Among patients having a postoperative transesophageal echocardiography, complete occlusion of the LAA was achieved in 45% (5/11) of cases using sutures and in 72% (24/33) using a stapler, P = .14. The rate of LAA occlusion by individual surgeons increased from 43% (9/21) to 87% (20/23) after performing 4 cases (P = .0001). After a mean follow-up of 13 ± 7 months, 2.6% of patients had thromboembolic events.
Conclusions: LAA occlusion at the time of CABG is safe. The rate of complete occlusion improves, to acceptable levels, with increased experience and the use of a stapling device. A large trial is needed to determine if LAA occlusion prevents stroke.
Atrial fibrillation (AF) is an important risk factor for stroke, and effective strategies for stroke prevention are needed. In the last 10 years, the use of oral anticoagulants in patients with AF has lead to a significant reduction in stroke. Still, stroke remains a major cause of serious disability and death in AF, and additional preventive strategies are needed. AF accounts for one sixth of all strokes, and up to 25% of strokes in patients aged >80 years. Many patients undergoing coronary artery bypass grafting (CABG) eventually develop AF and are at risk of AF-related stroke. Patients undergoing CABG aged >75 years, with a history of hypertension or with previous stroke, have risk factors for both AF and stroke. Approximately 90% of left atrial thrombi are found in the left atrial appendage (LAA), and thus surgical occlusion of this structure is an attractive method for potentially reducing stroke. In contrast to procedures for LAA occlusion done independently of other surgery, occlusion at the time of CABG may be done with little incremental time, cost, and risk. However, the safety and feasibility of LAA occlusion, at the time of CABG surgery, have never been evaluated in a randomized trial. This pilot study was conducted to assess the safety and feasibility of surgical LAA occlusion as a concomitant procedure to CABG.