# Chirurgische LAO-sluiting tijdens CABG blijft onderbenut — analyse van 35.700 patiënten

*geplaatst 2026-11-04 · Atriumfibrilleren · The Journal of surgical research · doi 10.1016/j.jss.2026.08.072 · https://hartvaat.nl/2026/11/01/chirurgische-lao-sluiting-tijdens-cabg-blijft-onderbenut-analyse-van-35-700-pati/*

Een retrospectieve analyse van 35.700 patiënten met atriumfibrilleren die een isolerende CABG ondergingen, toonde aan dat slechts 12,3% een chirurgische LAO-sluiting (s-LAAC) ontving. Hoewel het gebruik toenam, bleef s-LAAC onderbenut, met een lagere kans op cardiale bloedingen (aOR 0,75) en vergelijkbare mortaliteit. Hogere CHADS2-scores, vooroperatieve antistolling en behandeling in grote centra voorspelden gebruik, terwijl vrouwen en niet-Witte patiënten minder vaak de procedure kregen. Deze bevindingen benadrukken de behoefte aan gerichte inspanningen om dispariteiten in patiëntselectie aan te pakken en de preventie van beroerte na hartchirurgie te verbeteren.

## English: Left Atrial Appendage Closure Is Underutilized in Coronary Artery Bypass Graft Surgery.

A retrospective analysis of 35,700 patients with atrial fibrillation undergoing isolated CABG revealed that only 12.3% received surgical left atrial appendage closure (s-LAAC). Although utilization increased over time, s-LAAC remained underused and was associated with reduced cardiac bleeding (adjusted OR 0.75) without increasing mortality. Higher CHADS2 scores, preoperative anticoagulation, and treatment at large centers predicted adoption, while female sex and non-White race were linked to lower rates. These findings highlight persistent demographic disparities and underscore the need for targeted efforts to optimize stroke prevention and bleeding outcomes in this surgical population.

## Abstract (original, from the publication)

INTRODUCTION: The real-world utilization and practice patterns of surgical left atrial appendage closure (s-LAAC) during coronary artery bypass graft (CABG) surgery remains inadequately characterized. This study aims to evaluate the use, predictors, and temporal trends of s-LAAC in patients undergoing isolated CABG surgery using a nationwide database. METHODS: We performed a retrospective analysis of the National Inpatient Sample from 2016 to 2021, identifying patients with a diagnosis of atrial fibrillation who underwent isolated CABG surgery. Patients were stratified by whether they received s-LAAC. Baseline characteristics, clinical outcomes, and predictors of s-LAAC utilization were analyzed. RESULTS: Among 35,700 patients with atrial fibrillation undergoing isolated CABG, 4384 patients (12.3%) received s-LAAC. Utilization of s-LAAC increased significantly over time (Ptrend < 0.001). Compared to those who did not receive s-LAAC, patients undergoing s-LAAC had similar in-hospital mortality (adjusted odds ratio 1.11, 95% confidence interval 0.91-1.34) and reduced cardiac bleeding (adjusted odds ratio 0.75, 95% confidence interval 0.60-0.95). Independent predictors of s-LAAC included higher Congestive heart failure, Hypertension, Age, Diabetes, Stroke (CHADS2) score, preoperative anticoagulation, prior pacemaker placement, and treatment at a large hospital. Factors associated with lower likelihood of s-LAAC included female sex and non-White race. CONCLUSIONS: Despite a rising trend in s-LAAC use during CABG surgery, the procedure remains significantly underutilized. Targeted efforts to address underrepresented patient populations are essential to achieving more equitable and broader adoption of s-LAAC in CABG.

Auteurs: Hanil Kang, Patrick Warner, Charley Sun, Masashi Kawabori, Laura Piechura, Prem Shekar, Yong Zhan

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Bron: The Journal of surgical research, https://doi.org/10.1016/j.jss.2026.08.072. Bijgewerkt 2026-10-28T02:28:45Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.