Table 1.

Available Literature on Surgical Left Atrial Appendage Occlusion

Trial name	Year	Publication type	Surgical device used	Control arm	n	Mean follow‐up	Results
							Primary end point	Closure, %	Conclusions
Johnson et al 1	2000	Observational, retrospective	Excision	…	437		Technical feasibility and safety	100	Safe, suggested benefit in stroke prevention
Katz et al 25	2000	Observational, retrospective	Endocardial suture	…	50		Evaluate postsurgical success with TEE at differed points in time	64	Incomplete LAA ligation occurred in 36% of patients irrespective of surgical technique
Garcia‐Fernandez et al 26	2003	Observational, retrospective	Endocardial suture	…	205		Occurrence of embolic event	90	Positive stroke prevention
Bando et al 75	2003	Observational, retrospective	Endocardial suture	…	812		Occurrence of embolic event		Negative for stroke prevention
Blackshear et al 10	2003	Observational, prospective	Thoracoscopic epicardial purse string	…	15		Feasibility of snare loop procedure and stroke incidence	93	Positive trend toward stroke prevention
Pennec et al 76	2003	Observational, prospective series	Endocardial suture Excision	…	30		Safety and efficacy	70–80 100	Negative for stroke prevention Negative outcomes in intra‐atrial approach Positive for stroke prevention
Schneider et al 77	2005	Observational, prospective series	Endocardial suture	…	6		Safety and efficacy	17	Incomplete surgical LAA closure may promote rather than reduce the risk of stroke; need for TEE to verify occlusion
Healey et al 24	2005	Randomized controlled	Epicardial suture Stapler	No occlusion	77	13 ± 7 mo	Safety and efficacy	45 72	Safe at the time of CABG; positive for stroke prevention (2.6%)
Kanderian et al 78	2008	Observational, retrospective	Excision (52) Suture exclusion (85) Stapler	…	137		Comparison of effectiveness in surgical techniques	73 23 20	There is a high occurrence of unsuccessful surgical LAA closure; of the various techniques, excision appears to be the most successful
Bakhtiary et al 79	2008	Observational, prospective series	Clamp and epicardial suture	…	259		Safety, occurrence of stroke	100	Positive for stroke prevention
Ailawadi et al, EXCLUDE 28	2011	Observational, prospective series	AtriClip	…	75		Safety and efficacy	95	Safe and stable on short‐term postprocedural imaging
Whitlock et al, LAAOS II 80	2013	Cross‐sectional	Occlusion	No occlusion	1889	1 y	Safety and efficacy		LAA occlusion can be safely performed at the time of cardiac surgery; positive for stroke prevention
Whitlock et al, LAAOS III 31	2021	Randomized, controlled	Occlusion	No occlusion	4811	3 y	Stroke or systemic embolism		LAA occlusion during cardiac surgery reduced risk of ischemic stroke or systemic embolism in patients with atrial fibrillation

CABG indicates coronary artery bypass graft; EXCLUDE, The Exclusion of Left Atrial Appendage with AtriClip Exclusion Device in Patients Undergoing Concomitant Cardiac Surgery; LAA, left atrial appendage; LAAOS II, Left Atrial Appendage Occlusion During Cardiac Surgery to Prevent Stroke; LAAOS III, Left Atrial Appendage Occlusion During Cardiac Surgery to Prevent Stroke; and TEE, transesophageal echocardiogram.