Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation
Abstract
Background Left atrial appendage obliteration was historically ineffective for the prevention of postoperative stroke in patients with rheumatic atrial fibrillation who underwent operative mitral valvotomy. It is, however, a routine part of modern "curative" operations for nonrheumatic atrial fibrillation, such as the maze and corridor procedures.Methods To assess the potential of left atrial appendage obliteration to prevent stroke in nonrheumatic atrial fibrillation patients, we reviewed previous reports that identified the etiology of atrial fibrillation and evaluated the presence and location of left atrial thrombus by transesophageal echocardiography, autopsy, or operation.Results Twenty-three separate studies were reviewed, and 446 of 3,504 (13%) rheumatic atrial fibrillation patients, and 222 of 1,288 (17%) nonrheumatic atrial fibrillation patients had a documented left atrial thrombus. Anticoagulation status was variable and not controlled for. Thrombi were localized to, or were present in the left atrial appendage and extended into the left atrial cavity in 254 of 446 (57%) of patients with rheumatic atrial fibrillation. In contrast, 201 of 222 (91%) of nonrheumatic atrial fibrillation-related left atrial thrombi were isolated to, or originated in the left atrial appendage (p < 0.0001).Conclusions These data suggest that left atrial appendage obliteration is a strategy of potential value for stroke prophylaxis in nonrheumatic atrial fibrillation.
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AF implies an incremental risk for thromboembolism in patients with mitral valve stenosis.
“while AF implies an incremental risk for thromboembolism in patients with mitral valve stenosis”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [273]
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“Although all 4 Watchman studies excluded these contraindicated patients, in the Aspirin Plavix Registry (8), the devicewas implanted in 150 NVAF patients ineligible for warfarin.”
BackgroundInfluentialBoersma, L. V. A., Schmidt, B., Betts, T. R., Sievert, H., Tamburino, C., Teíger, E., Pokushalov, E., Kische, S., Schmitz, T., Steín, K. M., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehv730 · Cited by 522 · see citing works
The Left Atrial Appendage: Anatomy, Function, and Noninvasive Evaluation
Beigel, R., Wunderlich, N. C., Ho, S. Y., Arsanjani, R., & Siegel, R. J. (2014) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2014.08.009 · Cited by 519 · see citing works
“In 1909, Welch (4) noted that cardiovascular stroke associated with AF was due to left atrial appendage (LAA) thrombi and that this was the most common site for thrombus formation in the setting of AF (5).”
BackgroundAtrial Arrhythmia after Surgical Closure of Atrial Septal Defects in Adults
Gatzoulis, M. Α., Freeman, M. A., Siu, S. C., Webb, G. D., & Harris, L. (1999) · New England Journal of Medicine · doi:10.1056/nejm199903183401103 · Cited by 505 · see citing works
Healey, J. S., Crystal, E., Lamy, A., Teoh, K., Semelhago, L., Hohnloser, S. H., Cybulsky, I., Abouzahr, L., Sawchuck, C., Carroll, S., et al. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.09.054 · Cited by 496 · see citing works
Atrial Arrhythmias after Cardiothoracic Surgery
Ommen, S. R., Odell, J. A., & Stanton, M. S. (1997) · New England Journal of Medicine · doi:10.1056/nejm199705153362006 · Cited by 453 · see citing works
Ostermayer, S. H., Reisman, M., Kramer, P. H., Matthews, R. V., Gray, W. A., Block, P. C., Omran, H., Bartorelli, A. L., Bella, P. E. D., Mario, C. D., et al. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.03.042 · Cited by 444 · see citing works
“Percutaneous LAA occlusion is an improved method of a nown approach (7,20,21), excluding the LAA from blood ow and thus preventing thrombus formation and subseuent thromboembolic complications.”
MethodSievert, H., Lesh, M. D., Trepels, T., Omran, H., Bartorelli, A. L., Bella, P. D., Nakai, T., Reisman, M., Mario, C. D., Block, P. C., et al. (2002) · Circulation · doi:10.1161/01.cir.0000015698.54752.6d · Cited by 431 · see citing works
Boersma, L. V. A., Ince, H., Kische, S., Pokushalov, E., Schmitz, T., Schmidt, B., Gori, T., Meincke, F., Protopopov, A. V., Betts, T. R., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.05.038 · Cited by 433 · see citing works
“Introduction The left atrial appendage (LAA) has been implicated as the most common source of cardioembolic thrombi in nonvalvular atrial fibrillation (AF).(1) Left atrial appendage closure (LAAC) provides an attractive alternative to reduce the risk of stroke for those patients with a clinical rationale to prefer an…”
BackgroundPark, J., Bethencourt, A., Sievert, H., Santoro, G., Meier, B., Walsh, K. P., Lopez-Minquez, J. R., Meerkin, D., Valdés, M., Ormerod, O. J., et al. (2010) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.22764 · Cited by 422 · see citing works
“Thus, the attempt to exclude one of the main sources for ischemic stroke, the LAA, through a minimal invasive procedure to avoid anticoagulation is worth pursuing [23,26-28,39].”
BackgroundThe NCDR Left Atrial Appendage Occlusion Registry
Freeman, J. V., Varosy, P. D., Price, M. J., Slotwiner, D. J., Kusumoto, F. M., Rammohan, C., Kavinsky, C. J., Turi, Z. G., Akar, J. G., Koutras, C., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.12.040 · Cited by 421 · see citing works
Bartuś, K., Han, F. T., Bednarek, J., Myć, J., Kapelak, B., Sadowski, J., Lelakowski, J., Bartuś, S., Yakubov, S. J., & Lee, R. J. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.06.046 · Cited by 410 · see citing works
“There was no change in color flow Doppler within the left upper pulmonary vein during inflation of the balloon or closure of the snare, consistent with initial findings (22).”
BackgroundResultJCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease
Izumi, C., Eishi, K., Ashihara, K., Arita, T., Otsuji, Y., Kunihara, T., Komiya, T., Shibata, T., Seo, Y., Daimon, M., et al. (2020) · Circulation Journal · doi:10.1253/circj.cj-20-0135 · Cited by 371 · see citing works
EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update
Glikson, M., Wolff, R., Hindricks, G., Mandrola, J. M., Camm, A. J., Lip, G. Y. H., Fauchier, L., Betts, T. R., Lewalter, T., Saw, J., et al. (2020) · EuroIntervention · doi:10.4244/eijy19m08_01 · Cited by 366 · see citing works
“Some operators adjust the sheath configuration according to the left atrial and appendage morphology by bending the sheath and dilator based on fluoroscopy.(2) Once across the interatrial septum, the wire and dilator are removed and a pigtail catheter is inserted via the TorqVue sheath into the LAA.”
MethodSick, P. B., Schuler, G. C., Hauptmann, K. E., Grube, E., Yakubov, S. J., Turi, Z. G., Mishkel, G. J., ALMANY, S. L., & Holmes, D. R. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.02.035 · Cited by 351 · see citing works
EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update
Glikson, M., Wolff, R., Hindricks, G., Mandrola, J. M., Camm, A. J., Lip, G. Y. H., Fauchier, L., Betts, T. R., Lewalter, T., Saw, J., et al. (2019) · EP Europace · doi:10.1093/europace/euz258 · Cited by 332 · see citing works
Fernández, M. Á. G., David, E. P., Quiles, J., Peralta, J. P., García-Rojas, I., Bermejo, J., Moreno, M., & Silva, J. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00954-9 · Cited by 327 · see citing works
“In addition, warfarin levels are affected by a large number of dietary and drug factors (3).”
BackgroundEHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion
Meier, B., Blaauw, Y., Khattab, A. A., Lewalter, T., Sievert, H., Tondo, C., Glikson, M., ESC Scientific Document Group, Lip, G. Y. H., López-Mínguez, J. R., et al. (2014) · EP Europace · doi:10.1093/europace/euu174 · Cited by 327 · see citing works
Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.03.017 · Cited by 312 · see citing works
The left atrial appendage: our most lethal human attachment! Surgical implications✩
Johnson, W. D., Ganjoo, A. K., Stone, C. D., Srivyas, R. C., & Howard, M. (2000) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/s1010-7940(00)00419-x · Cited by 292 · see citing works
Go, A. S., Reynolds, K., Yang, J., Gupta, N., Lenane, J. C., Sung, S. H., Harrison, T. N., Liu, T., & Solomon, M. D. (2018) · JAMA Cardiology · doi:10.1001/jamacardio.2018.1176 · Cited by 290 · see citing works
Exclusion of the left atrial appendage with a novel device: Early results of a multicenter trial
Ailawadi, G., Gerdisch, M., Harvey, R. L., Hooker, R. L., Damiano, R. J., Salamon, T., & Mack, M. J. (2011) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2011.07.052 · Cited by 275 · see citing works
“There is evidence that up to 90% of embolic strokes that occur in patients with AF originate from the left atrial appendage (LAA).(2) In addition, the LAA is thought to be a driver for AF in a small group of patients with persistent AF.”
BackgroundMacle, L., Cairns, J. A., Leblanc, K., Tsang, T. S. M., Skanes, A. C., Cox, J. L., Healey, J. S., Bell, A., Pilote, L., Andrade, J. G., et al. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.07.591 · Cited by 271 · see citing works
Lip, G. Y. H., Collet, J. P., Haude, M., Byrne, R., Chung, E. H., Fauchier, L., Halvorsen, S., Lau, D. H., López-Cabanillas, N., Lettino, M., et al. (2018) · EP Europace · doi:10.1093/europace/euy174 · Cited by 278 · see citing works
“Left atrial appendage closure The left atrial appendage (LAA) is implicated in approximately 90% of strokes in patients with AF.95 Left atrial appendage occlusion, either percutaneous or surgical, is a rapidly-emerging option for patients who cannot take long-term OAC.96 Of the percutaneous options, the WATCHMAN (Bost…”
InfluentialGuidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination
Hahn, R. T., Abraham, T. P., Adams, M. S., Bruce, C. J., Glas, K. E., Lang, R. M., Reeves, S. T., Shanewise, J. S., Siu, S. C., Stewart, W. J., et al. (2013) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000000016 · Cited by 241 · see citing works
Fountain, R. B., Holmes, D. R., Chandrasekaran, K., Packer, D. L., Asirvatham, S. J., Tassel, R. A. V., & Turi, Z. G. (2006) · American Heart Journal · doi:10.1016/j.ahj.2006.02.005 · Cited by 233 · see citing works
Khurram, I. M., Dewire, J., Mager, M., Maqbool, F., Zimmerman, S. L., Zipunnikov, V. M., Beinart, R., Marine, J. E., SPRAGG, D. D., Berger, R. D., et al. (2013) · Heart Rhythm · doi:10.1016/j.hrthm.2013.09.065 · Cited by 219 · see citing works
Meier, B., Palacios, I. F., Windecker, S., Rotter, M., Cao, Q., Keane, D., Ruiz, C. E., & Hijazi, Z. M. (2003) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.10660 · Cited by 216 · see citing works
Tzikas, A., Holmes, D. R., Gafoor, S. A., Ruiz, C. E., Blomström‐Lundqvist, C., Diener, H., Cappato, R., Kar, S., Lee, R. J., Byrne, R. A., et al. (2016) · EP Europace · doi:10.1093/europace/euw141 · Cited by 216 · see citing works
Saw, J., Tzikas, A., Shakir, S., Gafoor, S. A., Omran, H., Nielsen‐Kudsk, J. E., Kefer, J., Aminian, A., Berti, S. L., Santoro, G., et al. (2017) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2016.11.029 · Cited by 214 · see citing works
“The rationale and mechanism of LAA closure in stroke prevention hinge on the observation from transesophageal echocardiographic (TEE) studies that about 91% of thrombi were located in the LAA in the setting of nonvalvular AF (1).”
BackgroundEarly Safety and Efficacy of Percutaneous Left Atrial Appendage Suture Ligation
Price, M. J., Gibson, D. N., Yakubov, S. J., Schultz, J. C., Biase, L. D., Natale, A., Burkhardt, J. D., Pershad, A., Byrne, T., Gidney, B., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.057 · Cited by 210 · see citing works
“The primary source of thromboembolism in atrial fibrillation appears to be the left atrial appendage (LAA) (2).”
BackgroundNucifora, G., Faletra, F. F., Regoli, F. D., Pasotti, E., Pedrazzini, G. B., Moccetti, T., & Auricchio, A. (2011) · Circulation Cardiovascular Imaging · doi:10.1161/circimaging.111.963892 · Cited by 204 · see citing works
“Discussion The results of the present study can be summarized as follows: (1) RT3DTEE-derived measurements of LAA orifice area are closely related with CT measurements, which is the gold standard for LAA anatomic evaluation; (2) 2DTEE significantly underestimates LAA dimension and orifice size, as compared with RT3DTE…”
ResultStructure and Function of the Left Atrium and Left Atrial Appendage
Delgado, V., Biase, L. D., Leung, M., Romero, J. E., Tops, L. F., Casadei, B., MARROUCHE, N. F., & Bax, J. J. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.10.063 · Cited by 213 · see citing works
“The LAA is a finger- or stump-like extension of the LA with lobes that may harbor up to 90% of thrombi that occur in patients with AF (35).”
BackgroundJCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias
Nogami, A., Kurita, T., Abe, H., Andò, K., Ishikawa, T., Imai, K., Usui, A., Okishige, K., Kusano, K., Kumagai, K., et al. (2021) · Circulation Journal · doi:10.1253/circj.cj-20-0637 · Cited by 203 · see citing works
Breithardt, G., Baumgartner, H., Berkowitz, S. D., Hellkamp, A. S., Piccini, J. P., Stevens, S. R., Lokhnygina, Y., Patel, M. R., Halperin, J. L., Singer, D. E., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu305 · Cited by 196 · see citing works
“Among patients with rheumatic AF, about half of thrombi were found in the left atrial appendage and the rest in its cavity, whereas in non-valvular AF, thrombi were predominantly found in the left atrial appendage.(22) This difference in location of thrombi may influence outcomes and efficacy of anticoagulant therapy.”
BackgroundYaghi, S. R., Bernstein, R. A., PASSMAN, R. S., Okin, P. M., & Furie, K. L. (2017) · Circulation Research · doi:10.1161/circresaha.116.308447 · Cited by 195 · see citing works
Patent foramen ovale: anatomy, outcomes, and closure
Calvert, P. A., Rana, B. S., Kydd, A. C., & Shapiro, L. M. (2011) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2010.224 · Cited by 195 · see citing works
“A review of 23 studies that included data from postmortem examinations and from patients who had undergone cardiac surgery confirmed these findings, with intracardiac thrombus found in 13% of patients with atrial fibrillation”
BackgroundMorin, D. P., Bernard, M. L., Madias, C. A., Rogers, P. A., Thihalolipavan, S., & Estes, N. A. M. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.08.022 · Cited by 196 · see citing works
2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation
Chiang, C., Okumura, K., Zhang, S., Chao, T., Siu, C., Lim, T. W., Saxena, A., Takahashi, Y., & Teo, W. S. (2017) · Journal of Arrhythmia · doi:10.1016/j.joa.2017.05.004 · Cited by 198 · see citing works
“Occlusion or excision of the LAA has been proposed as a way to reduce thromboembolic events [123].”
BackgroundDoes preoperative atrial fibrillation reduce survival after coronary artery bypass grafting?
Quader, M. A., McCarthy, P. M., Gillinov, A. M., Alster, J. M., Cosgrove, D. M., Lytle, B. W., & Blackstone, E. H. (2004) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2003.09.069 · Cited by 188 · see citing works
Friedman, D. J., Piccini, J. P., Wang, T., Zheng, J., Malaisrie, S. C., Holmes, D. R., Suri, R. M., Mack, M. J., Badhwar, V., Jacobs, J. P., et al. (2018) · JAMA · doi:10.1001/jama.2017.20125 · Cited by 186 · see citing works
“001 CABG and MV replacement 141 (4) 181 (3)”
Left Atrial Appendage Function and Stroke Risk
Yaghi, S. R., Song, C., Gray, W. A., Furie, K. L., Elkind, M. S. V., & Kamel, H. (2015) · Stroke · doi:10.1161/strokeaha.115.011273 · Cited by 176 · see citing works
“Then there are additional and smaller forward and retrograde waves, which are thought to be caused by ventricular relaxation and LAA elasticity.31 In a study using tissue Doppler imaging with TEE and transthoracic echocardiography (TTE) to characterize LAA myocardial function by measuring LAA contraction velocity that…”
BackgroundInfluentialBayard, Y. L., Omran, H., Neužil, P., Thuesen, L., Pichler, M., Rowland, E., Ramondo, A. B., Rużyłło, W., Budts, W., Montalescot, G., et al. (2010) · EuroIntervention · doi:10.4244/eijv6i2a35 · Cited by 175 · see citing works
Cresti, A., Fernández, M. Á. G., Sievert, H., Mazzone, P., Baratta, P., Solari, M., Geyer, A., Sensi, F. D., & Limbruno, U. (2019) · EuroIntervention · doi:10.4244/eij-d-19-00128 · Cited by 168 · see citing works
Occluding the left atrial appendage: anatomical considerations
Su, P., McCarthy, K. P., & Ho, S. Y. (2007) · Heart · doi:10.1136/hrt.2006.111989 · Cited by 166 · see citing works
JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias
Nogami, A., Kurita, T., Abe, H., Andò, K., Ishikawa, T., Imai, K., Usui, A., Okishige, K., Kusano, K., Kumagai, K., et al. (2021) · Journal of Arrhythmia · doi:10.1002/joa3.12491 · Cited by 164 · see citing works
Tzikas, A., Holmes, D. R., Gafoor, S. A., Ruiz, C. E., Blomström‐Lundqvist, C., Diener, H., Cappato, R., Kar, S., Lee, R. J., Byrne, R. A., et al. (2016) · EuroIntervention · doi:10.4244/eijv12i1a18 · Cited by 164 · see citing works
Yao, X., Gersh, B. J., Holmes, D. R., Melduni, R. M., Johnsrud, D. O., Sangaralingham, L. R., Shah, N. D., & Noseworthy, P. A. (2018) · JAMA · doi:10.1001/jama.2018.6024 · Cited by 163 · see citing works
Blackshear, J. L., Johnson, W. D., Odell, J. A., Baker, V. S., Howard, M., Pearce, L. A., Stone, C. D., Packer, D. L., & Schaff, H. V. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00953-7 · Cited by 161 · see citing works
Percutaneous Interventions for Left Atrial Appendage Exclusion
Wunderlich, N. C., Beigel, R., Swaans, M. J., Ho, S. Y., & Siegel, R. J. (2015) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2015.02.002 · Cited by 157 · see citing works
Percutaneous Left Atrial Appendage Closure
Saw, J., & Lempereur, M. (2014) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2014.05.026 · Cited by 155 · see citing works
“Transesophageal echocardiography (TEE), autopsy, and surgical reports confirmed that >90% of nonrheumatic AF-related left atrial thrombi were isolated to, or originated from, the left atrial appendage (LAA) (17).”
BackgroundFeasibility of closed-chest ligation of the left atrial appendage in humans
Bartuś, K., Bednarek, J., Myć, J., Kapelak, B., Sadowski, J., Lelakowski, J., Yakubov, S. J., & Lee, R. J. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.10.040 · Cited by 154 · see citing works
Melduni, R. M., Schaff, H. V., Lee, H.-C., Gersh, B. J., Noseworthy, P. A., Bailey, K. R., Ammash, N. M., Cha, S. S., Fatema, K., Wysokiński, W. E., et al. (2016) · Circulation · doi:10.1161/circulationaha.116.021952 · Cited by 151 · see citing works
Mahajan, R., Brooks, A. G., Sullivan, T., Lim, H. S., Alasady, M., Abed, H. S., Ganesan, A. N., Nayyar, S., Lau, D. H., Roberts‐Thomson, K. C., et al. (2012) · Heart · doi:10.1136/heartjnl-2012-301799 · Cited by 146 · see citing works
“Reports have suggested that the left atrial appendage (LAA) is the dominant location of thrombus in non-valvular AF and has led to the development of LAA occlusion as a therapeutic modality to reduce stroke risk.(5) However, most of these reports have included only small and selected patient cohorts, such that the pat…”
BackgroundMahapatra, S., LaPar, D. J., Kamath, S., Payne, J. J., Bilchick, K. C., Mangrum, J. M., & Ailawadi, G. (2011) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2011.02.045 · Cited by 144 · see citing works
“LAA Removal and LOM Ablation Besides its likely contribution to strokes, the LAA is important as a substrate and, in some studies, a driver of AF in up to 28% of patients [21, 27].”
BackgroundRationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III.
Whitlock, R. P., Healey, J. S., Vincent, J., Brady, K., Teoh, K., Royse, A. G., Shah, P. J., Guo, Y., Alings, M., Folkeringa, R., et al. (2014) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2225-319x.2013.12.06 · Cited by 144 · see citing works
“Clinical and diagnostic imaging evidence indicates that at least 70% of all strokes in patients with AF are cardio-embolic from the left atrium (1) and 90% of these arise from the LAA in data from echocardiographic and autopsy studies (2).”
BackgroundSCAI/HRS expert consensus statement on transcatheter left atrial appendage closure
Saw, J., Holmes, D. R., Cavalcante, J. L., Freeman, J. V., Goldsweig, A. M., Kavinsky, C. J., Moussa, I. D., Munger, T. M., Price, M. J., Reisman, M., et al. (2023) · Heart Rhythm · doi:10.1016/j.hrthm.2023.01.007 · Cited by 140 · see citing works
Lee, R., Vassallo, P., Kruse, J. T., Malaisrie, S. C., Rigolin, V. H., Andrei, A., & McCarthy, P. M. (2016) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2016.06.009 · Cited by 138 · see citing works
Antithrombotic Therapy After Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation
Freeman, J. V., Higgins, A. Y., Wang, Y., Du, C., Friedman, D. J., Daimee, U. A., Minges, K. E., Pereira, L., Goldsweig, A. M., Price, M. J., et al. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.02.047 · Cited by 138 · see citing works
Septal Pouch in the Left Atrium
Krishnan, S., & Salazar, M. (2010) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2009.07.017 · Cited by 137 · see citing works
Önalan, O., & Crystal, E. (2007) · Stroke · doi:10.1161/01.str.0000250166.06949.95 · Cited by 134 · see citing works
Pillarisetti, J., Reddy, Y. M., Gunda, S., Swarup, V., Lee, R. J., Rasekh, A., Horton, R., Massumi, A., Cheng, J., Bartuś, K., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.020 · Cited by 133 · see citing works
Dawson, A. G., Asopa, S., & Dunning, J. (2009) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1510/icvts.2009.227991 · Cited by 133 · see citing works
Lupercio, F. A., Ruiz, J. C., Briceno, D. F., Romero, J. E., Villablanca, P. A., Berardi, C., FAILLACE, R. T., KRUMERMAN, A. K., Fisher, J. D., Ferrick, K. J., et al. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.03.042 · Cited by 133 · see citing works
Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism
Nakai, T., Lesh, M. D., Gerstenfeld, E. P., Virmani, R., Jones, R., & Lee, R. J. (2002) · Circulation · doi:10.1161/01.cir.0000015605.30810.51 · Cited by 131 · see citing works
Thoracoscopic obliteration of the left atrial appendage: Potential for stroke reduction?
Odell, J. A., Blackshear, J. L., Davies, E. J., Byrne, W. J., Kollmorgen, C. F., Edwards, W. D., & Orszulak, T. A. (1996) · The Annals of Thoracic Surgery · doi:10.1016/0003-4975(95)00885-3 · Cited by 126 · see citing works
Left atrial appendage occlusion
Holmes, D. R., Korsholm, K., Rodés‐Cabau, J., Saw, J., Berti, S. L., & Alkhouli, M. A. (2023) · EuroIntervention · doi:10.4244/eij-d-22-00627 · Cited by 126 · see citing works
Prediction of left atrial appendage thrombi in non-valvular atrial fibrillation
Habara, S., Dote, K., Kato, M., Sasaki, S., Goto, K., Takemoto, H., Hasegawa, D., & Matsuda, O. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm356 · Cited by 123 · see citing works
The prothrombotic state in atrial fibrillation: pathophysiological and management implications
Khan, A. A., & Lip, G. Y. H. (2018) · Cardiovascular Research · doi:10.1093/cvr/cvy272 · Cited by 123 · see citing works
“Changes in the morphology of the LAA and the left atrium occur as a result of AF, which can be correlated to subsequent thromboembolism.3 Several clinical trials have assessed the benefit of closing LAA in reducing stroke risk in patients with AF but with mixed results thus far.33,34 The LAA is also a source of AF dev…”
BackgroundInfluentialBergmann, M., Betts, T. R., Sievert, H., Schmidt, B., Pokushalov, E., Kische, S., Schmitz, T., Meincke, F., Steín, K. M., Boersma, L. V. A., et al. (2017) · EuroIntervention · doi:10.4244/eij-d-17-00042 · Cited by 122 · see citing works
Brandes, A., Crijns, H. J. G. M., Rienstra, M., Kirchhof, P. F., Grove, E. L., Pedersen, K. B., & Gelder, I. C. V. (2020) · EP Europace · doi:10.1093/europace/euaa057 · Cited by 122 · see citing works
Left Atrial Appendage Occlusion Study II (LAAOS II)
Whitlock, R. P., Vincent, J., Blackall, M. H., Hirsh, J., Fremes, S. E., Novick, R. J., Devereaux, P. J., Teoh, K., Lamy, A. L., Connolly, S. J., et al. (2013) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2013.06.015 · Cited by 121 · see citing works
“Based on a review of these and other studies, it was concluded that at least 90% of left atrial thrombi are found in the LAA.9 It is therefore reasonable to propose that occlusion of the LAA would greatly reduce the risk of stroke in patients with AF.10 To date, no conclusive evidence exists that LAA exclusion is effe…”
ResultMassumi, A., Chelu, M. G., Nazeri, A., May, S., Afshar-Kharaghan, H., Saeed, M., Razavi, M., & Rasekh, A. (2013) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2012.11.061 · Cited by 120 · see citing works
- Authors
- Blackshear, J. L., & Odell, J. A.
- Affiliations
- Mayo Clinic (US)
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 1996-02
- Volume
- 61
- Issue
- 2
- Pages
- 755-759
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2053482681
- Cited by
- 1,686
- References
- 61
- Citations by year
- 2026: 78 · 2025: 68 · 2024: 98 · 2023: 112 · 2022: 93 · 2021: 108 · 2020: 126 · 2019: 100 · 2018: 111 · 2017: 121 · 2016: 100 · 2015: 125 · 2014: 81 · 2013: 75 · 2012: 61
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, postoperative stroke, stroke prevention, left atrial thrombus, non-valvular atrial fibrillation, cardiac surgery, mitral valve surgery, maze procedure, anticoagulation
- MeSH terms
- Contraindications, Aged, Atrial Fibrillation, Cerebrovascular Disorders, Heart Atria, Heart Diseases, Humans, Mitral Valve Stenosis, Postoperative Complications, Thrombosis, Warfarin
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