Left Atrial Appendage Occlusion Study (LAAOS): Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke

Healey, Jeff S.; Crystal, Eugene; Lamy, Andre; Teoh, Kevin; Semelhago, Lloyd; Hohnloser, Stefan H.; Cybulsky, Irene; Abouzahr, Labib; Sawchuck, Corey; Carroll, Sandra; Morillo, Carlos; Kleine, Peter; Chu, Victor; Lonn, Eva; Connolly, Stuart J.

doi:10.1016/j.ahj.2004.09.054

« Previous Next »American Heart Journal
Volume 150, Issue 2 , Pages 288-293, August 2005

Left Atrial Appendage Occlusion Study (LAAOS): Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke

Jeff S. Healey, MD
- McMaster University, Hamilton, Ontario, Canada
- Reprint requests: Jeff Healey, MD, McMaster University–General Site, 237 Barton St. East, Hamilton, Ontario, Canada L8L 2X2.
Eugene Crystal, MD
- University of Toronto, Toronto, Ontario, Canada
Andre Lamy, MD
- McMaster University, Hamilton, Ontario, Canada
Kevin Teoh, MD
- McMaster University, Hamilton, Ontario, Canada
Lloyd Semelhago, MD
- McMaster University, Hamilton, Ontario, Canada
Stefan H. Hohnloser, MD
- J. W. Goethe University, Frankfurt, Germany
Irene Cybulsky, MD
- McMaster University, Hamilton, Ontario, Canada
Labib Abouzahr, MD
- McMaster University, Hamilton, Ontario, Canada
Corey Sawchuck, MD
- McMaster University, Hamilton, Ontario, Canada
Sandra Carroll, BSc
- McMaster University, Hamilton, Ontario, Canada
Carlos Morillo, MD
- McMaster University, Hamilton, Ontario, Canada
Peter Kleine, MD
- J. W. Goethe University, Frankfurt, Germany
Victor Chu, MD
- McMaster University, Hamilton, Ontario, Canada
Eva Lonn, MD
- McMaster University, Hamilton, Ontario, Canada
Stuart J. Connolly, MD
- McMaster University, Hamilton, Ontario, Canada

Received 9 May 2004; accepted 20 September 2004.

Aim

This pilot study assessed the safety and efficacy of left atrial appendage (LAA) occlusion, performed at the time of coronary artery bypass grafting (CABG).

Methods and results

At the time of CABG, 77 patients with risk factors for stroke were randomized to LAA occlusion or control. The LAA was occluded using sutures or a stapling device. Completeness of occlusion was assessed with transesophageal echocardiography. There were no significant differences in cardiopulmonary bypass duration, perioperative heart failure, atrial fibrillation, or bleeding between the 2 groups. During surgery, there were 9 appendage tears, all of which were repaired easily with sutures. Among patients having a postoperative transesophageal echocardiography, complete occlusion of the LAA was achieved in 45% (5/11) of cases using sutures and in 72% (24/33) using a stapler, P = .14. The rate of LAA occlusion by individual surgeons increased from 43% (9/21) to 87% (20/23) after performing 4 cases (P = .0001). After a mean follow-up of 13 ± 7 months, 2.6% of patients had thromboembolic events.

Conclusions

LAA occlusion at the time of CABG is safe. The rate of complete occlusion improves, to acceptable levels, with increased experience and the use of a stapling device. A large trial is needed to determine if LAA occlusion prevents stroke.