# pLAAO en S-LAAO reduceren trombo-embolisch risico bij niet-valvulair AF — narratieve review

*geplaatst 2026-09-16 · Atriumfibrilleren · Current problems in cardiology · doi 10.1016/j.cpcardiol.2026.103426 · https://hartvaat.nl/2026/11/01/plaao-en-s-laao-reduceren-trombo-embolisch-risico-bij-niet-valvulair-af-narratie/*

Deze narratieve review vergelijkt de percutane (pLAAO) en chirurgische (S-LAAO) sluiting van het linkeratriumappendage bij patiënten met niet-valvulair atriumfibrilleren en een contra-indicatie voor orale anticoagulatie. Beide technieken reduceren het trombo-embolische risico effectief; S-LAAO heeft het sterkste bewijs bij gelijktijdige hartchirurgie (LAAOS III), terwijl pLAAO in geselecteerde populaties niet-inferieur blijkt aan orale anticoagulatie. Een gedeelde uitdaging is onvolledige sluiting, wat zorgvuldige beeldvorming vereist. Omdat geen van beide benaderingen superieur is, blijven prospectieve vergelijkende studies en gestandaardiseerde nasleepbehandeling essentieel voor de dagelijkse praktijk.

## English: Percutaneous and surgical left atrial appendage occlusion in non-valvular atrial fibrillation: Contemporary narrative review.

This narrative review compares percutaneous (pLAAO) and surgical (S-LAAO) left atrial appendage closure in non-valvular atrial fibrillation patients who cannot tolerate oral anticoagulation. Both approaches effectively reduce thromboembolic risk, with robust evidence supporting S-LAAO during concomitant cardiac surgery (LAAOS III) and pLAAO demonstrating noninferiority to oral anticoagulation in selected cohorts. Incomplete closure remains a shared limitation, necessitating meticulous pre- and intraprocedural imaging. As neither technique proves superior, the review emphasizes the need for direct comparative trials and standardized postprocedural antithrombotic strategies to guide clinical decision-making.

## Abstract (original, from the publication)

BACKGROUND: Left atrial appendage occlusion (LAAO) reduces thromboembolic risk in patients with atrial fibrillation (AF) who have contraindications to oral anticoagulation (OAC). LAAO can be performed surgically (S-LAAO) or percutaneously (pLAAO), but direct comparative evidence remains limited. METHODS: We conducted a contemporary narrative review of evidence for S-LAAO and pLAAO, emphasizing randomized controlled trials (RCTs) and systematic reviews (SRs), with and without meta-analyses. A focused PubMed/MEDLINE search evaluated procedural safety, thromboembolic outcomes, and completeness of LAA exclusion. Preprocedural, intraprocedural, and postprocedural imaging evidence was additionally assessed using guidelines, expert consensus statements, observational studies, and emerging clinical trials. RESULTS: RCTs and SRs support both S-LAAO and pLAAO for reducing thromboembolic events. S-LAAO reduces stroke and systemic embolism when performed during concomitant cardiac surgery, with the strongest evidence from LAAOS III. Evidence for isolated S-LAAO, including epicardial AtriClip closure, remains limited. pLAAO has been evaluated in multiple RCTs and SRs and has demonstrated noninferiority to OAC in selected populations. Incomplete LAA exclusion remains a concern with both approaches, manifesting as residual stumps after surgical closure and peri-device leaks after percutaneous implantation. TEE and cardiac CT remain key imaging modalities, while ICE, CMR, and DSA/fluoroscopy-guided techniques are increasingly investigated. CONCLUSION: Both S-LAAO and pLAAO effectively reduce thromboembolic risk; however, evidence does not establish superiority of one approach. Evidence is substantially greater for pLAAO, whereas S-LAAO is primarily studied during concomitant cardiac surgery. Direct comparative studies are needed. Future research should address residual LAA patency, postprocedural antithrombotic therapy, and emerging imaging strategies.

Auteurs: Julian A Chestaro, Hannah Price, Joel Matthews, Parth Adrejiya, Trevor Stepanyan, Larissa Check, Shashikanth Nagabandi, Rami N Khouzam

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Bron: Current problems in cardiology, https://doi.org/10.1016/j.cpcardiol.2026.103426. Bijgewerkt 2026-09-10T00:49:32Z. 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.