Department of Internal Medicine, SIU School of Medicine, Springfield, Illinois.
Department of Internal Medicine, SIU School of Medicine, Springfield, Illinois.
Am J Cardiol. 2019 Oct 15;124(8):1218-1225. doi: 10.1016/j.amjcard.2019.07.032. Epub 2019 Aug 1.
Surgical left atrial appendage occlusion (S-LAAO) has become a common procedure performed in patients undergoing cardiac surgery; however, evidence to support this procedure remains inconclusive. This meta-analysis aims to assess the efficacy of S-LAAO in terms of ischemic stroke, postoperative atrial fibrillation, and all-cause mortality. A thorough literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We identified 10 relevant studies for our meta-analysis. It included 6,779 patients who underwent S-LAAO and 6,573 who did not undergo LAAO. In terms of ischemic stroke, the S-LAAO cohort had a lower events (pooled odds ratio [OR] 0.655 (0.518 to 0.829), p = 0.0004) compared with the non-LAAO cohort. S-LAAO cohort also had lower events of all-cause mortality (pooled OR 0.74 (95% confidence interval 0.55 to 0.99), p = 0.0408) when compared with the non-LAAO cohort. In regards to postoperative atrial fibrillation, there was no difference between the 2 groups (pooled OR 1.29 (95% confidence interval 0.81 to 2.06), p = 0.2752). In conclusion, S-LAAO was associated with lower events of ischemic stroke or systemic embolism and all-cause mortality when compared to the non-LAAO group.
经心外科手术进行的左心耳封堵术(S-LAAO)已成为一种常见的手术方法;然而,支持该手术的证据仍不明确。本荟萃分析旨在评估 S-LAAO 在缺血性卒中、术后心房颤动和全因死亡率方面的疗效。我们按照系统评价和荟萃分析的首选报告项目进行了全面的文献回顾。我们确定了 10 项相关研究进行荟萃分析。这些研究共纳入 6779 例接受 S-LAAO 的患者和 6573 例未接受 LAAO 的患者。在缺血性卒中方面,S-LAAO 组的事件发生率较低(汇总优势比 [OR] 0.655(0.518 至 0.829),p=0.0004)。与非 LAAO 组相比,S-LAAO 组的全因死亡率事件也较低(汇总 OR 0.74(95%置信区间 0.55 至 0.99),p=0.0408)。至于术后心房颤动,两组之间无差异(汇总 OR 1.29(95%置信区间 0.81 至 2.06),p=0.2752)。总之,与非 LAAO 组相比,S-LAAO 与较低的缺血性卒中或全身性栓塞及全因死亡率相关。