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  • Reply to Left Atrial Appendage Closure During Cardiac Surgery for Atrial Fibrillation: A Meta-Analysis

    We congratulate Prasad et al.  on their meta-analysis supporting concomitant surgical left atrial appendage (LAA) closure as an effective and safe procedure to reduce the risk of stroke and systemic embolism in patients with a history of atrial fibrillation. The authors found a pooled 25% relative risk reduction (LAA closure 3.74% versus no LAA closure 4.88%, risk ratio [RR] 0.75, 95% confidence interval [CI] 0.64–0.87, p = 0.0002) when combining randomized controlled trials (RCTs). Prasad et al. observed directionally similar risk reductions in the composite of stroke and systemic embolism when comparing RCT data (RR 0.67, 95% CI 0.53–0.84) to data from observational studies (RR 0.76, 95% CI 0.65–0.90).

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