Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysis

International Journal of Cardiology: Heart & Vasculature

Mahmoud Nassar¹  Mpey Tabot-Tabot²  Yolanda Mbome²  Most S. Munira³  Allison Foster³  Rubal Bhangal³  Tanveer Shaukat³  Laura Guzman³  Sofia Lakhdar³  Solomon Badejoko³  Mohsen Alshamam³  Nso Nso³  Milana Zirkiyeva³  Vincent Rizzo⁴  Anthony Lyonga Ngonge⁵  Senthil Thambidorai⁶ 

[1] Corresponding author at: 17004 Henley Rd Unit 4B, Jamaica NY, 11432.;Department of Medicine, Howard University Hospital, Washington, DC, USA;Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA;Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA;Department of Medicine, St. Joseph’s Medical Center, Stockton, CA, USA;Division of Cardiovascular Disease, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA;

关键词: Left atrial appendage occlusion;    Direct oral anticoagulants;    Vitamin K antagonists;    Atrial fibrillation;    Stroke;    All-cause mortality;   

DOI  :  

来源: DOAJ

【 摘 要 】

Surgical left atrial appendage occlusion (LAAO) is being used increasingly in the setting of atrial fibrillation but has been associated with procedural complications. This systematic review and meta-analysis compared the outcomes of surgical LAAO with those of no LAAO and the use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) using the PRISMA guidelines. A literature search was undertaken for relevant studies published between January 1, 2003, and August 15, 2021. Primary clinical outcomes were all-cause mortality, embolic events, and stroke. Secondary clinical outcomes included major adverse cardiac events (MACE), postoperative atrial fibrillation, postoperative complications, reoperation for bleeding, and major bleeding. There was a statistically significant 34% reduction in incidence of embolic events (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.57–0.77, p < 0.001) and a significant 42% reduction in risk of MACE (OR 0.58, 95% CI 0.38–0.88, p = 0.01) in patients who underwent LAAO.Surgical LAAO has the potential to reduce embolic events and MACE in patients undergoing cardiac surgery for atrial fibrillation. However, complete replacement of DOACs and warfarin therapy with surgical LAAO is unlikely despite its non-inferiority in terms of minimizing all-cause mortality, embolic events, MACE, major bleeding, and stroke in patients on oral anticoagulation therapies.

【 授权许可】

Unknown