Study Finds No Significant Benefit of Left Atrial Appendage Occlusion After Valvular Surgery in Some Patients

Recent research presented at ESC Congress 2025 has questioned the efficacy of surgical left atrial appendage occlusion (SLAAO) in reducing stroke and cardiovascular death among high-risk patients without atrial fibrillation (AF) undergoing valvular surgery. The study, known as the OPINION trial, involved over 2,100 participants across three Chinese cardiac centers, with an average age of 56 years and a baseline risk score (CHA₂DS₂VASc) of 2.9. Patients were randomly assigned to receive standard surgery with or without SLAAO. Intraoperative transesophageal echocardiography confirmed the completeness of the occlusion, with immediate revision if residual openings exceeded 1 cm. The primary outcome measured was a composite of ischemic stroke, transient ischemic attack (TIA), or cardiovascular mortality at one year.

Results revealed no significant difference between the two groups: 6.9% of patients in the SLAAO group experienced the outcomes compared to 8.2% in the control group, with a hazard ratio of 0.83 (p=0.25). Secondary endpoints, including all components of the primary measure and bleeding complications, were also similar. Subgroup analyses suggested a possible trend toward benefit in patients with even higher risk scores (CHA₂DS₂VASc ≥3), but this was not conclusive.

Lead author Dr. Xin Yuan emphasized that routine SLAAO does not confer a clear advantage in this patient population, potentially sparing patients from unnecessary surgical procedures. The trial highlights the need for alternative stroke prevention strategies, such as anticoagulation, in high-risk non-AF patients after valvular interventions. Follow-up will extend beyond three years to further explore potential long-term benefits.

This study underscores the importance of evidence-based surgical decisions and suggests that current approaches to stroke risk reduction in these patients may need reassessment. Source: https://medicalxpress.com/news/2025-09-lack-benefit-left-atrial-appendage.html