Outcomes don’t assist routine closure of the left atrial appendage in all sufferers present process open-heart surgical procedure however these at excessive stroke threat could profit. This was the primary conclusion of the LAACS-2 trial offered in a Scorching Line session right this moment at ESC Congress 2026.
Following open-heart surgical procedure, sufferers face a excessive long-term threat of stroke. The left atrial appendage (LAA) is a small muscular pouch within the coronary heart’s left atrium, which is understood to be a typical supply of blood clots in sufferers who’ve atrial fibrillation (AF). Surgical closure of the LAA is really helpful in ESC Tips as an adjunct to oral anticoagulation for sufferers with AF present process cardiac surgical procedure. Nevertheless, proof is missing in sufferers with out a identified historical past of AF.
Affiliate Professor Helena Dominguez from Bispebjerg College Hospital, Copenhagen, Denmark and colleagues beforehand carried out the LAACS trial in sufferers present process open-heart surgical procedure.
With long-term follow-up, we noticed decrease threat of stroke after LAA closure whether or not the affected person had AF or not. We carried out the a lot bigger LAACS-2 trial to additional examine if LAA closure has a protecting impact in sufferers with, however principally with out, prior AF.”
Helena Dominguez, Affiliate Professor, Bispebjerg College Hospital, Copenhagen, Denmark
The LAACS-2 trial was carried out throughout 4 websites in Denmark, Spain and Sweden. Sufferers present process first-time deliberate open-heart surgical procedure with out AF and people with a earlier analysis of paroxysmal or continual AF have been included. A complete of 1,500 sufferers have been randomised (1:1) to both concomitant LAA closure or customary care (open LAA). The imply age was 67 years and 18.5% have been feminine. Earlier than surgical procedure, 4.1% had AF, 6.1% had prior stroke and a pair of.5% had prior transient ischaemic assault.
Throughout a median of 4.0 years’ follow-up, there was no important distinction within the main consequence of stroke or transient ischaemic assault with LAA closure vs. customary care (4.28% vs. 5.04%, respectively; hazard ratio 0.85; 95% confidence interval 0.53 to 1.37; p=0.517).
Of word, sufferers who had the best stroke threat at baseline (CHA2DS2-VASc rating above the median) had a 56% discount within the main endpoint with LAA closure (p=0.018), whereas no important profit was noticed in these with decrease stroke threat.
General, there was no important distinction in mortality between the teams.
“Our outcomes don’t assist routine LAA closure in all sufferers present process deliberate cardiac surgical procedure. Nevertheless, closure appeared to confer safety in sufferers at excessive threat of stroke,” concluded Affiliate Professor Dominguez. “As we noticed within the LAACS trial, the first endpoint curves diverged over time in LAACS-2 and follow-up can be continued.” Affiliate Professor Dominguez highlighted an ongoing mechanistic examine that goals to additional perceive stroke threat following LAA closure in sufferers present process open-heart surgical procedure.
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