Left atrial appendage closure during open-heart surgery only beneficial for high-risk patients
Results do not support routine closure of the left atrial appendage in all patients undergoing open-heart surgery, but those at high stroke risk may benefit. This was the main conclusion of the LAACS-2 trial presented in a Hot Line session today at ESC Congress 2026.
The LAACS-2 trial presented at ESC Congress 2026 suggests that routine closure of the left atrial appendage (LAA) during open-heart surgery is not beneficial for all patients, but may provide protection for those at high stroke risk. The study, conducted across four sites in Denmark, Spain, and Sweden, involved 1,500 patients undergoing first-time planned open-heart surgery, with half receiving LAA closure and the other half receiving standard care.
Over a median follow-up period of 4.0 years, the research found no significant difference in the primary outcome of stroke or transient ischemic attack between the two groups (4.28% vs. 5.04%, respectively). However, patients with a higher stroke risk at baseline, as determined by the CHA2DS2-VASc score, showed a 56% reduction in the primary endpoint with LAA closure (p = 0.018).
The study concludes that routine LAA closure is not recommended for all patients undergoing planned cardiac surgery, but could be beneficial for those at high risk of stroke.
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