Prophylactic left atrial appendage occlusion during mitral valve repair in patients without atral fibrillation: A meta-analysis of time to event data

Authors

• Ahmed Emara, Faculty of Medicine Al-Azhar University Cairo Egypt.
• Ameer Awashra, Department of Medicine An Najah National University Nablus Palestine.
• Mohamed S. Elgendy, Faculty of Medicine Tanta University Tanta Egypt.
• Mohamed R. Murad, Faculty of Medicine Al-Azhar University Cairo Egypt.
• Mohamed Emara, Faculty of Medicine Al-Azhar University Cairo Egypt.
• Abubakar Nazir, Department of Medicine Mercy Health-The Jewish Hospital Cincinnati Ohio USA.
• Abdalhakim Shubietah, Advocate Health - MidwestFollow
• Michael Megaly, Integris Health Heart Hospital Oklahoma City Oklahoma USA.
• Vinayak N. Bapat, Department of Cardiac Surgery, Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota USA.

Recommended Citation

Emara A, Awashra A, Elgendy MS, et al. Prophylactic Left Atrial Appendage Occlusion During Mitral Valve Repair in Patients Without Atral Fibrillation: A Meta-Analysis of Time to Event Data. J Arrhythm. 2026;42(3):e70355. Published 2026 May 3. doi:10.1002/joa3.70355

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: Mitral valve repair (MVr) is effective for mitral regurgitation, but the benefit of prophylactic left atrial appendage occlusion (LAAO) in patients without prior atrial fibrillation (AF) remains unclear. This meta-analysis aimed to assess the long-term safety and efficacy of LAAO in this understudied population.

Methods: We performed a meta-analysis from four major databases until December 2025. Kaplan-Meier curves data were reconstructed and analyzed using Cox regression models and hazard ratios (HR) for thromboembolic events (mainly stroke). A random-effects meta-analysis was performed with R software to calculate risk ratios (RR), hazard ratios (HR), and mean differences (MD), all with 95% confidence intervals (CIs).

Results: Three studies with 5048 patients were included. LAAO was associated with a significant reduction in thromboembolic risk at 5 years (HR 0.60, 95% CI 0.46 to 0.77). LAAO reduced in-hospital stroke (RR 0.43, 95% CI 0.25 to 0.72) but increased postoperative AF (RR 1.17, 95% CI 1.09 to 1.26). No significant differences were observed in 30-day mortality (RR 0.56, 95% CI 0.07 to 4.33) or hospital stay (MD -0.16 days, 95% CI - 0.48 to 0.16).

Conclusions: Prophylactic LAAO during MVr in patients without AF may reduce thromboembolic events risk but appears to increase postoperative AF. Further randomized studies are warranted.

Type

Article

PubMed ID

42089094