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
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 ant...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906722000471 |
| _version_ | 1818007600365568000 |
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| author | Nso Nso Mahmoud Nassar Milana Zirkiyeva Sofia Lakhdar Tanveer Shaukat Laura Guzman Mohsen Alshamam Allison Foster Rubal Bhangal Solomon Badejoko Anthony Lyonga Ngonge Mpey Tabot-Tabot Yolanda Mbome Vincent Rizzo Most S. Munira Senthil Thambidorai |
| author_facet | Nso Nso Mahmoud Nassar Milana Zirkiyeva Sofia Lakhdar Tanveer Shaukat Laura Guzman Mohsen Alshamam Allison Foster Rubal Bhangal Solomon Badejoko Anthony Lyonga Ngonge Mpey Tabot-Tabot Yolanda Mbome Vincent Rizzo Most S. Munira Senthil Thambidorai |
| author_sort | Nso Nso |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-14T05:17:45Z |
| format | Article |
| id | doaj.art-b66c6e604f0e40cda9101cc2e9b7946e |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-04-14T05:17:45Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-b66c6e604f0e40cda9101cc2e9b7946e2022-12-22T02:10:19ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672022-06-0140100998Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysisNso Nso0Mahmoud Nassar1Milana Zirkiyeva2Sofia Lakhdar3Tanveer Shaukat4Laura Guzman5Mohsen Alshamam6Allison Foster7Rubal Bhangal8Solomon Badejoko9Anthony Lyonga Ngonge10Mpey Tabot-Tabot11Yolanda Mbome12Vincent Rizzo13Most S. Munira14Senthil Thambidorai15Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USA; Corresponding author at: 17004 Henley Rd Unit 4B, Jamaica NY, 11432.Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADepartment of Medicine, St. Joseph’s Medical Center, Stockton, CA, USADepartment of Medicine, Howard University Hospital, Washington, DC, USADepartment of Medicine, Howard University Hospital, Washington, DC, USADepartment of Medicine, Richmond University Medical Center, Staten Island, NY, USADepartment of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USADivision of Cardiovascular Disease, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, NY, USAChief of Cardiovascular Medicine Division, HCA Medical City of Fort Worth, TX/ Assistant Professor of Medicine -TCU and UNTHSc School of Medicine, Fort Worth, TX, USASurgical 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.http://www.sciencedirect.com/science/article/pii/S2352906722000471Left atrial appendage occlusionDirect oral anticoagulantsVitamin K antagonistsAtrial fibrillationStrokeAll-cause mortality |
| spellingShingle | Nso Nso Mahmoud Nassar Milana Zirkiyeva Sofia Lakhdar Tanveer Shaukat Laura Guzman Mohsen Alshamam Allison Foster Rubal Bhangal Solomon Badejoko Anthony Lyonga Ngonge Mpey Tabot-Tabot Yolanda Mbome Vincent Rizzo Most S. Munira Senthil Thambidorai 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 Left atrial appendage occlusion Direct oral anticoagulants Vitamin K antagonists Atrial fibrillation Stroke All-cause mortality |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Left atrial appendage occlusion Direct oral anticoagulants Vitamin K antagonists Atrial fibrillation Stroke All-cause mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2352906722000471 |
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