- Question
- Does surgical occlusion of the left atrial appendage during cardiac surgery performed for another indication reduce ischemic stroke and systemic embolism in patients with atrial fibrillation?
- Design
- Multicenter randomized trial with blinding of participants, research personnel and primary care physicians (other than the surgeons). The primary analysis population included 2379 patients in the occlusion group and 2391 in the no-occlusion group, followed for a mean of 3.8 years.
- Population
- Patients with atrial fibrillation and a CHA2DS2-VASc score of at least 2 who were scheduled for cardiac surgery for another indication. Mean age was 71 years and mean CHA2DS2-VASc score was 4.2.
- Intervention
- Surgical occlusion of the left atrial appendage during the operation, using a suture, a surgical stapler or an approved closure device, in addition to usual care including oral anticoagulation.
- Control
- Cardiac surgery without left atrial appendage occlusion, with stroke prevention managed according to best medical practice as decided by the primary care physician.
- Primary outcome
- Occurrence of ischemic stroke (including transient ischemic attack with positive neuroimaging) or systemic embolism.
- Results
- Stroke or systemic embolism occurred in 114 participants (4.8%) in the occlusion group and 168 (7.0%) in the no-occlusion group (HR 0.67; 95% CI 0.53 to 0.85; P = 0.001). A total of 92.1% received the assigned procedure, and at 3 years 76.8% were still receiving oral anticoagulation.
- Safety
- The incidence of perioperative bleeding, heart failure or death did not differ significantly between the groups.
- Conclusion
- In patients with atrial fibrillation undergoing cardiac surgery, concomitant left atrial appendage occlusion lowered the risk of ischemic stroke or systemic embolism, even though most patients continued anticoagulation.
- Why it matters
- It provided randomized evidence that surgical appendage occlusion adds stroke protection on top of anticoagulation in patients with atrial fibrillation already undergoing cardiac surgery, supporting its routine consideration in that setting.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026