You Can Refer to
Surgical LAA Exclusion
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AF and Stroke Risk

Thrombus in the Left Atrial Appendage (LAA) is believed to be the primary cause of stroke in AF patients2,4

Evidence in numbers:

91% of thrombus formations
were located in the LAA (review of 23 studies)1

5x greater risk of stroke
(and greater severity) in AF patients than non-AF patients, even after adjustment for other factors such as age, hypertension9-14

2x greater risk of mortality
caused by stroke than in non-AF patients9

40% reduced risk of stroke
originating in the LAA13

Improving Lives With LAAE

LAAE has been shown to reduce ischemic stroke risk for AF patients undergoing concomitant surgery15

Patient benefits: Outcomes

The results of the LAAOS III randomised control trial show that concomitant LAAE improves outcomes compared with no-LAAE in AF patients.

Results showed a lower risk of ischemic stroke or systemic embolism in AF patients with LAAE performed during surgery than without it.


Adapted from reference13

Expert Consensus

LAAE consideration in eligible patients with AF is supported by major expert bodies2,6-8

Positive support across the board

Major expert bodies including EHRA/EAPCI, AHA/ACC/ARS, ESC/EACTS and STS support LAAE consideration in eligible AF patients undergoing concomitant surgery.

Summary of society recommendations related to LAAE

PM-EU-3966A-0127-G

References

Clinical results are not predictive and individual results may vary.

  1. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61(2):755-759.
  2. Glikson M, Wolff R, Hindricks G, et al. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update. EuroIntervention. 2020;15(13):1133-1180.
  3. Hanke T. Surgical management of the left atrial appendage: a must or a myth? Eur J Cardiothorac Surg. 2018;53(suppl_1):i33-i38.
  4. Johnson WD, Ganjoo AK, Stone CD, Srivyas RC, Howard M. The left atrial appendage: our most lethal human agachment! Surgical implications. Eur J Cardiothorac Surg. 2020;17(6):718-722.
  5. van Laar C, Verberkmoes NJ, Es HW, et al. Thoracoscopic left atrial appendage clipping. JACC: Clinical Electrophysiology. 2018;4(7):893-901.
  6. Badhwar V, Rankin JS, Damiano RJ, Jr., et al. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac . 2017;103(1):329-341.
  7. Hindricks G, Potpara T, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. ;42:373-498.
  8. Writing Group M, January CT, Wann LS, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial llation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. ;16(8):e66-e93.
  9. Ali AN, Abdelhafiz A. Clinical and Economic Implications of AF Related Stroke. J Atr Fibrillation. 2016;8(5):1279. Authors pooled data from 15 studies.
  10. Health Policy Partnership. White Paper on inequalities and unmet needs in the detection of atrial fibrillation (AF) and use of therapies to prevent AF related stroke in Europe. 2018
  11. Cullen MW, Stulak JM, Li Z, et al. Left Atrial Appendage Patency at Cardioversion After Surgical Left Atrial Appendage Intervention. Ann Thorac Surg. 2016;101(2):675-681.
  12. Soltesz EG, Dewan KC, Anderson LH, Ferguson MA, Gillinov AM. Improved outcomes in CABG patients with atrial fibrillation associated with surgical left atrial appendage usion. J Card Surg. 2021;36(4):1201-1208.
  13. Whitlock RP, Belley-Cote EP, Paparella D, et al. Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N Engl J Med. 2021;384(22): 2081-2091.
  14. Wolf PA, Abbog RD, Kannel WB. Atrial fibrillation is an independent risk factor for stroke: The Framingham Study. Stroke. 1991;22:983-8.

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