ReviewFuture cardiology2025
Challenges and solutions for optimizing outcomes in patients undergoing surgical left atrial appendage closure.
Review in Future cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Left atrial appendage closure (LAAC) during cardiac surgery is a pivotal strategy for stroke prevention in atrial fibrillation (AF), gaining recognition in guidelines (Class I AHA 2023, Class IIa ESC 2024). This review identifies critical challenges and proposes solutions for optimizing outcomes. Challenges 1) Patient Selection: Significant controversy exists regarding extending LAAC to high-stroke-risk patients without documented AF ;(CHA₂DS₂-VASc ≥2), where 50% of post-cardiac surgery strokes occur, creating an evidence-practice gap. Conflicting meta-analyses exist (Baudo et al. vs. Kowalewski et al.). 2) Technique Standardization: Marked heterogeneity in surgical techniques (suture, excision, stapling) and lack of standardized protocols lead to highly variable success rates (0%-100%), unlike standardized clipping (AtriClip®; > 93% success). 3)Post-procedural Management: Unresolved debates persist on optimal post-surgical antithrombotic regimens and the standalone efficacy of LAAC vs. anticoagulation. Solutions 1) Ongoing RCTs (LeAAPS, LAA-CLOSURE, LAACS-2) aim to define LAAC efficacy in non-AF populations. 2) Implement evidence-based standardized operating procedures (SOPs) for each technique, prioritizing validated clipping devices. Promote unified imaging criteria (transesophageal echocardiography(TEE) intra-operation, Cardiac Computed Tomography Angiography(CCTA) follow-up) per AHA 2023 guidelines. 3) The LAA-CLIP trial is evaluating thoracoscopic clipping vs. DOACs, potentially supporting anticoagulation simplification post-LAAC. Addressing these challenges through standardization and targeted trials is crucial for maximizing LAAC efficacy.
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