Surgical left atrial appendage closure during open heart surgery may protect against long-term cerebral ischemic events based on results from the LAACS study presented at ESC Congress 2017 in Barcelona.

The study randomized 187 patients referred for coronary artery bypass grafting, valve surgery or both, to either surgical closure of the left atrial appendage (101 patients) or no closure (86 patients). The primary endpoint was the occurrence of stroke/transient ischemic attack (TIA) or silent cerebral infarction. All patients underwent a brain MRI before surgery, shortly after discharge and six months (or longer) after surgery.

Overall, 19 patients reached the combined endpoint during an average follow up of 3.65 years. Study investigators noted the cumulative probability of an ischemic brain event was consistently lower in the left atrial appendage closure group, compared with the non-closure group. The intention-to-treat analysis showed 16.3 percent (14 of 86) patients met the combined endpoint in the non-closure group, compared with 5 percent (5 of 101) in the left atrial appendage closure group.

LAAC Principal Investigator, Jesper Park-Hansen, MD, Bispebjerg/Frederiksberg University Hospital, Copenhagen, Denmark, noted this is the first randomized study of surgical left atrial appendage closure that indicates a long-term protective effect. “Based on the LAACS study, it would be advisable to systematically add surgical closure of the left atrial appendage to planned open heart surgery,” he said. “Our results need to be replicated in larger cohorts that can also confirm the safety of the procedure.” 

Keywords: ESC Congress, ESC2017, Ischemic Attack, Transient, Atrial Appendage, Intention to Treat Analysis, Stroke, Coronary Artery Bypass, Cardiac Surgical Procedures, Brain, Magnetic Resonance Imaging, Cerebral Infarction, Denmark

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