Surgical left atrial appendage occlusion (LAAO) after valve surgery did not significantly reduce the risk of ischemic stroke, transient ischemic attack (TIA) and cardiovascular mortality at one year compared with no surgical LAAO in high-risk patients without atrial fibrillation (AFib), based on findings from the OPINION trial presented at ESC Congress 2025.

Researchers at three cardiac surgery centers in China randomized 2,118 patients (mean age of 56 years/33% female) to standard surgical care with concomitant surgical LAAO or no surgical LAAO. All eligible patients had no previous AFib, a CHA₂DS₂VASc ≥2 and an indication for valvuloplasty or replacement due to mitral or aortic valve lesions.

The primary endpoint – a composite of ischemic stroke, TIA or cardiovascular mortality at one year – occurred in 6.9% of patients in the surgical LAAO group and 8.2% of patients in the non-surgical LAAO group. No significant difference was observed in secondary endpoints, including components of the primary endpoint and bleeding events. Study investigators also noted general consistency across prespecified subgroup analyses, apart from a potential benefit of surgical LAAO in high-risk patients with CHA₂DS₂VASc ≥3.

"Our results may help avoid unnecessary procedures and guide future research," said Xin Yuan, MD, first author of the study. "We have planned further analyses of surgical LAAO in high-risk subgroups and, given the divergence in primary endpoint event curves observed after six months, we are extending follow-up to three years. Beyond surgical LAAO, optimization of stroke prevention in high-risk patients after valvular surgery may lie in other strategies, including anticoagulation."