Cited by 1,686Atrial Fibrillation Management and OutcomesCardiac tumors and thrombiCardiovascular and Diving-Related Complications

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Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation

Blackshear, Joseph L., Odell, John A.·1996·The Annals of Thoracic Surgery

DOI 10.1016/0003-4975(95)00887-x

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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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Method
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Background
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Method
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Background
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Background
2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation
Macle, 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 275
2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the European Heart Rhythm Association (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA)
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 281
“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…”
Influential
Guidelines 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 246
The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients with Atrial Fibrillation) Trial
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
Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation
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
Transcatheter left atrial appendage occlusion with Amplatzer devices to obviate anticoagulation in patients with atrial fibrillation
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
Percutaneous left atrial appendage occlusion: the Munich consensus document on definitions, endpoints, and data collection requirements for clinical studies
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 219
Incidence and Clinical Impact of Device-Associated Thrombus and Peri-Device Leak Following Left Atrial Appendage Closure With the Amplatzer Cardiac Plug
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
“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).”
Background
Early 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 212
“The primary source of thromboembolism in atrial fibrillation appears to be the left atrial appendage (LAA) (2).”
Background
Evaluation of the Left Atrial Appendage With Real-Time 3-Dimensional Transesophageal Echocardiography
Nucifora, 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
“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…”
Result
Structure 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
“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).”
Background
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) · Circulation Journal · doi:10.1253/circj.cj-20-0637 · Cited by 205
Clinical characteristics and outcomes with rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trial
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
“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.”
Background
Cryptogenic Stroke
Yaghi, 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
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
“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”
Background
The State of the Art
Morin, 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 201
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 200
“Occlusion or excision of the LAA has been proposed as a way to reduce thromboembolic events [123].”
Background
Does 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
Association Between Left Atrial Appendage Occlusion and Readmission for Thromboembolism Among Patients With Atrial Fibrillation Undergoing Concomitant Cardiac Surgery
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 187
“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
“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…”
BackgroundInfluential
PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) for prevention of cardioembolic stroke in non-anticoagulation eligible atrial fibrillation patients: results from the European PLAATO study
Bayard, 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
Prevalence of extra-appendage thrombosis in non-valvular atrial fibrillation and atrial flutter in patients undergoing cardioversion: a large transoesophageal echo study
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
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
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 166
Percutaneous left atrial appendage occlusion: the Munich consensus document on definitions, endpoints and data collection requirements for clinical studies
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
Association of Surgical Left Atrial Appendage Occlusion With Subsequent Stroke and Mortality Among Patients Undergoing Cardiac Surgery
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 165
Thoracoscopic extracardiac obliteration of the left atrial appendage for stroke risk reduction in atrial fibrillation
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
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
Percutaneous Left Atrial Appendage Closure
Saw, J., & Lempereur, M. (2014) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2014.05.026 · Cited by 157
“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).”
Background
Feasibility 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
Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality
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
Importance of the underlying substrate in determining thrombus location in atrial fibrillation: implications for left atrial appendage closure
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
“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…”
Background
Initial Experience of Sequential Surgical Epicardial-Catheter Endocardial Ablation for Persistent and Long-Standing Persistent Atrial Fibrillation With Long-Term Follow-Up
Mahapatra, 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
“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].”
Background
Rationale 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
“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).”
Background
SCAI/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
A randomized, prospective pilot comparison of 3 atrial appendage elimination techniques: Internal ligation, stapled excision, and surgical excision
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
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 140
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
Left Atrial Appendage Exclusion for Stroke Prevention in Patients With Nonrheumatic Atrial Fibrillation
Önalan, O., & Crystal, E. (2007) · Stroke · doi:10.1161/01.str.0000250166.06949.95 · Cited by 134
Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications
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 135
Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion?
Dawson, A. G., Asopa, S., & Dunning, J. (2009) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1510/icvts.2009.227991 · Cited by 133
Left atrial appendage morphology assessment for risk stratification of embolic stroke in patients with atrial fibrillation: A meta-analysis
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
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
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
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
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
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
“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…”
BackgroundInfluential
Safety and efficacy of early anticoagulation drug regimens after WATCHMAN left atrial appendage closure: three-month data from the EWOLUTION prospective, multicentre, monitored international WATCHMAN LAA closure registry
Bergmann, 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
Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure
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 139
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
“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…”
Result
Initial Experience With a Novel Percutaneous Left Atrial Appendage Exclusion Device in Patients With Atrial Fibrillation, Increased Stroke Risk, and Contraindications to Anticoagulation
Massumi, 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 121

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)
DOI: 10.1016/0003-4975(95)00887-x
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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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Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation

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