Commentary: Concomitant LAA Closure; A No-Brainer to Protect the Brain?

  • Patrick M. McCarthy
    Address reprint requests to Patrick M. McCarthy, MD, Northwestern Medical Group, Chief of the Cardiac Surgery Division, Division of Cardiac Surgery, Heller-Sacks Professor of Surgery at the Northwestern University Feinberg School of Medicine, Northwestern University, 676 North Saint Clair St, Arkes Family Pavilion, Suite 730, Chicago, Illinois 60611.
    Division of Cardiac Surgery, Department of Surgery, Northwestern Medicine, Northwestern University, Chicago, Illinois.
    Search for articles by this author
  • Jane Kruse
    Division of Cardiac Surgery, Department of Surgery, Northwestern Medicine, Northwestern University, Chicago, Illinois.
    Search for articles by this author
      The data to support closure of the LAA in patients with AF undergoing cardiac surgery is very strong. The next study of LAA closure in patients without AF will add important information.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Seminars in Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Madsen CV
        • Park-Hansen J
        • Holme SJV
        • et al.
        Randomized trial of surgical left atrial appendage closure: protection against cerebral events.
        Semin Thorac Cardiovasc Surg. 2022; ([In press])
        • Healey JS
        • Connolly SJ
        • Gold MR
        • et al.
        Subclinical atrial fibrillation and the risk of stroke.
        N Engl J Med. 2012; 366: 120-129
        • Johnson WD
        • Ganjoo AK
        • Stone CD
        • et al.
        The left atrial appendage: our most lethal human attachment! Surgical implications.
        Eur J Cardiothorac Surg. 2000; 17: 718-722
        • Friedman DJ
        • Piccini JP
        • Wang T
        • et al.
        Association between left atrial appendage occlusion and readmission for thromboembolism among patients with atrial fibrillation undergoing concomitant cardiac surgery.
        JAMA. 2018; 319: 365-374
        • Melduni RM
        • Schaff HV
        • Lee HC
        • et al.
        Impact of left atrial appendage closure during cardiac surgery on the occurrence of early postoperative atrial fibrillation, stroke, and mortality: a propensity score-matched analysis of 10 633 patients.
        Circulation. 2017; 135: 366-378
      1. Ando M, Funamoto M, Cameron DE, et al. Concomitant surgical closure of left atrial appendage: A systematic review and meta-analysis. J thorac cardiovas surg 156:1071–1080.e1072, 20118.

        • Martín Gutiérrez E
        • Castaño M
        • Gualis J
        • et al.
        Beneficial effect of left atrial appendage closure during cardiac surgery: a meta-analysis of 280 585 patients.
        Eur J Cardiothorac Surg. 2020; 57: 252-262
        • Whitlock RP
        • Belley-Cote EP
        • Paparella D
        • et al.
        Left atrial appendage occlusion during cardiac surgery to prevent stroke.
        New Engl J Med. 2021;
        • Toale C
        • Fitzmaurice GJ
        • Eaton D
        • et al.
        Outcomes of left atrial appendage occlusion using the AtriClip device: a systematic review.
        Interact Cardiovasc Thorac Surg. 2019; 29: 655-662

      Linked Article

      • Randomized Trial of Surgical Left Atrial Appendage Closure: Protection Against Cerebrovascular Events
        Seminars in Thoracic and Cardiovascular Surgery
        • Preview
          Following open-heart surgery, atrial fibrillation and stroke occur frequently. Left atrial appendage closure added to elective open-heart surgery could reduce the risk of ischemic stroke. We aim to examine if routine closure of the left atrial appendage in patients undergoing open-heart surgery provides long-term protection against cerebrovascular events independently of atrial fibrillation history, stroke risk, and oral anticoagulation use. Long-term follow-up of patients enrolled in the prospective, randomized, open-label, blinded evaluation trial entitled left atrial appendage closure by surgery (NCT02378116).
        • Full-Text
        • PDF
        Open Access