Trial reportJournal of cardiothoracic surgery2018
Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study.
Trial report in Journal of cardiothoracic surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 24 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Can We Protect the Brain Against Thrombus Embolism by Closing the Left Atrial Appendage During Open Heart Surgery
Left Atrial Appendage Closure by Surgery-2
The Left Atrial Appendage Closure by Surgery and the Incidence of Stroke in Patients Undergoing Open-heart Surgery Irrespective of Preoperative Atrial Fibrillation Status and Stroke Risk.
Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2024Guideline
- Guideline
- Different Techniques of Surgical Left Atrial Appendage Closure and Their Efficacy: A Systematic Review.Reviews in cardiovascular medicine · 2023Pooled it
- Concomitant left atrial appendage exclusion during cardiac surgery: a single-center case series on technique profile, residual flow, and early safety.Journal of cardiothoracic surgery · 2026Article
- Medium-to-long-term success rate of left atrial appendage closure using endocardial sutures and postoperative anticoagulant strategies.Frontiers in cardiovascular medicine · 2026Article
- Surgical Left Atrial Appendage Occlusion During Cardiac Surgery in Atrial Fibrillation: A Contemporary Systematic Review and Meta-Analysis.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Review
- Challenges and solutions for optimizing outcomes in patients undergoing surgical left atrial appendage closure.Future cardiology · 2025Review
- Position paper of the Polish Society of Cardiothoracic Surgeons and the Heart Rhythm Association of the Polish Society of Cardiology on atrial fibrillation hybrid management.Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2025Article
- Postoperative Transesophageal Echocardiographic Evaluation of Surgical Left Atrial Appendage Exclusion: Characterization and Predictors of Success.Structural heart : the journal of the Heart Team · 2025Article
- LAA Thrombus and Stroke From Surgical LAA Closure Failure From Suture Insufficiency Treated With LAAO.JACC. Case reports · 2025Article
- [Surgical closure of the left atrial appendage for thromboembolism prophylaxis].Herzschrittmachertherapie & Elektrophysiologie · 2025Review
- The clinical impact of prophylactic concomitant left atrial appendage occlusion during cardiac surgery: A systematic review and meta-analysis.American heart journal plus : cardiology research and practice · 2025Article
- Clinical management after surgical left atrial appendage exclusion.Journal of cardiothoracic surgery · 2025Article
- Left Atrium Compression by Iatrogenic Hematoma Due to Left Atrial Appendage Clipping in Open Coronary Artery Bypass Grafting Surgery.Methodist DeBakey cardiovascular journal · 2025Article
- Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Review
- Atrial appendage closure is associated with increased risk for postoperative atrial fibrillation.Journal of cardiothoracic surgery · 2024Article
- A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion.Journal of cardiovascular development and disease · 2024Review
- Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke.JTCVS open · 2024Article
- Article
- 2023 APHRS expert consensus statements on surgery for AF.Journal of arrhythmia · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOpen heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by left atrial appendage closure with surgery (LAACS). However, the protective effect of LAACS on the risk of cerebral ischemia following cardiac surgery remains controversial. We have studied whether LAACS in addition to open heart surgery protects against post-operative ischemic brain injury regardless of a previous AF diagnosis.
methodsOne hundred eighty-seven patients scheduled for open heart surgery were enrolled in a prospective, open-label clinical trial and randomized to concomitant LAACS vs. standard care. Randomization was stratified by usage of oral anticoagulation (OAC) planned to last at least 3 months after surgery. The primary endpoint was a composite of post-operative symptomatic ischemic stroke, transient ischemic attack or imaging findings of silent cerebral ischemic (SCI) lesions.
resultsDuring a mean follow-up of 3.7 years, 14 (16%) primary events occurred among patients receiving standard surgery vs. 5 (5%) in the group randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1-0.8, p = 0.02). In per protocol analysis (n = 141), 14 (18%) primary events occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1-1.0, p = 0.05).
conclusionsIn a real-world setting, LAACS in addition to elective open-heart surgery was associated with lower risk of post-operative ischemic brain injury. The protective effect was not conditional on AF/OAC status at baseline.
trial registrationLAACS study, clinicaltrials.gov NCT02378116 , March 4th 2015, retrospectively registered.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.