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  • Letter to the Editor Regarding Left Atrial Appendage Closure During Cardiac Surgery for Atrial Fibrillation: A Meta-Analysis

    We appreciate the support from Eagle et al. in their recent reply  to our meta-analysis  that bolsters the theory that the risk of stroke and systemic embolism can effectively and safely be decreased via concomitant surgical left atrial appendage closure (LAAC). The notion of extending the Left Atrial Appendage Occlusion Study (LAAOS) III's study follow-up duration past the current study's total follow-up period of five years and a mean of 3.8 years is an exciting one  . The Left Atrial Appendage Closure with Surgery (LAACS) study conducted by Park-Hansen et al.  is the current randomized control trial with the longest follow-up period as the patients were followed for up to six years with a mean of 3.7 ± 1.6 years. Additionally, the LAAOS III trial would provide exponentially more data in this long-term period as 97.9% of their 4811 patients completed a five-year follow-up as compared to 98.9% of only 187 patients completing the six-year follow-up in the LAACS trial. In addition to the Society of Thoracic Surgeons 2017 guidelines (class IIA, level of evidence C)  , the European Society of Cardiology 2020 guidelines (class IIb, level of evidence C)  should also be updated in regards to the surgical treatment for atrial fibrillation. Thus, we look forward to the new data and results that Eagle et al. will publish regarding the LAAOS III trial and will be eager to report the results with an updated meta-analysis.

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