No Clear Benefit From Surgical Left Atrial Appendage Occlusion In Non-af Patients After Valve Surgery

No use successful position of prevention of ischemic stroke, transient ischemic onslaught and cardiovascular mortality aft 1 twelvemonth was observed erstwhile surgical near atrial appendage occlusion was performed successful high-risk non-atrial fibrillation patients aft valvular surgery, according to late-breaking investigation presented successful a Hot Line convention coming astatine ESC Congress 2025.

Surgical near atrial appendage occlusion (SLAAO) is simply a process designed to artifact nan near atrial appendage, which is simply a communal tract for clot formation.

While SLAAO reduces changeable successful atrial fibrillation (AF) patients, its efficacy successful high-risk non-AF patients remains uncertain. We conducted nan OPINION proceedings to reside this important objective mobility - does SLAAO trim thromboembolic events successful non-AF patients astatine precocious consequence of changeable aft valvular surgery?"

Professor nan Wang, trial presenter, from nan State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China

OPINION was an open-label, randomised, superiority proceedings conducted astatine 3 cardiac room centres successful China. Eligibility criteria included property >18 years, nary AF diagnosis, CHA₂DS₂VASc ≥2 and an denotation for valvuloplasty aliases replacement owed to mitral aliases aortic valve lesions. Participants were randomised 1:1 to modular surgical attraction pinch concomitant SLAAO aliases without SLAAO. Intraoperative transoesophageal echocardiography was mandatory to measure nan SLAAO, pinch contiguous surgical revision required if nan residual appendage stump exceeded 1 cm aft nan first closure attempt. The superior endpoint was a composite of ischaemic stroke, transient ischaemic attack (TIA) aliases cardiovascular mortality assessed astatine 1 twelvemonth utilizing nan intention-to-treat (ITT) principle.

The ITT organization included 2,118 patients who had a mean property of 56 years and 33% were female. The mean CHA₂DS₂VASc people was 2.9.

The superior endpoint of ischaemic stroke, TIA aliases cardiovascular mortality was not importantly different betwixt nan groups, occurring successful 6.9% of patients successful nan SLAAO group and 8.2% of patients successful nan power group (hazard ratio [HR] 0.83; 95% assurance interval [CI] 0.61 to 1.14; p=0.25).

There was nary important quality successful secondary endpoints, including components of nan superior endpoint and bleeding events. Prespecified subgroup analyses were mostly consistent, though location was a proposal of use pinch SLAAO successful high-risk patients pinch CHA₂DS₂VASc ≥3 (HR 0.81; 95% CI 0.56 to 1.17).

Summarizing nan results, first author, Doctor Xin Yuan, besides from nan State Key Laboratory of Cardiovascular Disease, said: "The proceedings recovered nary important use of regular SLAAO successful nan wide study population. Our results whitethorn thief debar unnecessary procedures and guideline early research. We person planned further analyses of SLAAO successful high-risk subgroups and, fixed nan divergence successful superior endpoint arena curves observed aft 6 months, we are extending follow-up to 3 years. Beyond SLAAO, optimisation of changeable prevention successful high-risk patients aft valvular room whitethorn dishonesty successful different strategies, including anticoagulation."