Researchers have found in a new study that adding Left Atrial Appendage Occlusion (LAAO) during cardiac surgery in patients with atrial fibrillation (AF) significantly reduces the risk of cardioembolic stroke, lowers stroke-related disability, and decreases mortality due to stroke. The findings highlight LAAO as a valuable protective strategy for AF patients undergoing cardiac surgery. The study was published in JAMA Neurology by Aristeidis H. and colleagues.
Atrial fibrillation is a major risk factor for cardioembolic stroke, and the left atrial appendage is a key source of thrombus formation. Appreciation of the role of surgical LAAO in stroke prevention will inform clinical decision-making in this high-risk population. This exploratory analysis of the LAAOS III trial involved patients recruited from 105 centers in 27 countries between July 2012 and October 2018. The participants were adults with AF and a CHA2DS2-VASc score ≥2 who were undergoing cardiac surgery for other indications. It compared surgical LAAO plus standard care versus standard care alone.
Stroke outcome data were adjudicated from June 28, 2023, to November 29, 202,3 and main analyses were performed from December 18, 2023, through April 29, 2024. Primary outcomes included functional outcome at day 7 or discharge (whichever came first) as assessed by the modified Rankin Scale (mRS), 30-day mortality following a stroke, presence of cortical infarcts on neuroimaging, and ischemic strokes of presumed cardioembolic origin.
Results
• Of 4,811 participants followed for an average of 3.8 years, 273 experienced a first ischemic stroke.
• The mean age at stroke was 75 years (SD 7); 104 (38%) were female and 169 (62%) male.
• Of the patients treated with LAAO, functional outcomes were better after stroke, as evidenced by lower mRS scores at 7 days or discharge (pooled OR 0.80; 95% CI 0.65-0.99).
• There was also reduced 30-day mortality post-stroke (16.5% vs 20.1%; HR 0.55; 95% CI 0.31-0.97).
• Neuroimaging showed that the LAAO group had fewer cortical infarcts, 46.2% versus 61.3% (difference, −15.2%; 95% CI, −26.7% to −3.7%), and a lower proportion of strokes of presumed cardioembolic etiology, 42.9% versus 57.9% (difference, −15.1%; 95% CI, −26.5% to −3.7%), when compared with the no-LAAO group.
This post hoc analysis of the LAAOS III trial demonstrates that surgical LAAO in patients with AF undergoing cardiac surgery is associated with a reduced risk of cardioembolic stroke, reduced disability, and lower 30-day mortality post-stroke. These findings reinforce the clinical value of LAAO as a stroke-preventive strategy in patients with AF requiring cardiac surgery.
Reference:
Katsanos AH, Whitlock RP, Belley-Côté EP, et al. Stroke Mechanism and Severity After Left Atrial Appendage Occlusion: Insights From the LAAOS III Randomized Clinical Trial. JAMA Neurol. Published online November 17, 2025. doi:10.1001/jamaneurol.2025.4478
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