The DOI matches its Crossref record; 59 of the 61 references it cites were found in a registry or an index.
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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“while AF implies an incremental risk for thromboembolism in patients with mitral valve stenosis”
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“Because thrombus formation in most cases is located in the left atrial appendage (1), an alternative treatment is to exclude the appendage from the blood circulation.”
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“Recently, several studies (Agmon et al., 2002; Al Saady et al., 1999; Blackshear and Odell, 1996; Kamp et al., 1999; Tabata et al., 1997) have stressed the importance of the left atrial appendage in the development of strokes, especially in those suffering from atrial fibrillation (abnormal heart rhythm).”
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Yaghi, S. R., Chang, A., Akiki, R. K., Collins, S., Novack, T., Hemendinger, M., Schomer, A., Grory, B. M., Cutting, S., Burton, T. M., et al. (2019) · Journal of cardiovascular computed tomography · doi:10.1016/j.jcct.2019.04.005 · Cited by 68
Badheka, A. O., Chothani, A., Mehta, K. D., Patel, N., Deshmukh, A. J., Hoosien, M., Shah, N. N., Singh, V., Grover, P. M., Savani, G. T., et al. (2014) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.114.001413 · Cited by 67
“42 Left atrial appendage (LAA) is the most common source (>90%) of cardioembolic stroke in atrial fibrillation (AF).(1) Although most common treatment for stroke prevention is systemic anticoagulation, for selected subgroup of AF patients who have contraindication or difficulty in medication adherence, nonpharmacologi…”
BackgroundPotpara, T., Grygier, M., Hæusler, K. G., Nielsen‐Kudsk, J. E., Berti, S. L., Genovesi, S., Marijon, É., Bovéda, S., Tzikas, A., Boriani, G., et al. (2024) · EP Europace · doi:10.1093/europace/euae035 · Cited by 78
Raphael, C. E., Friedman, P., Saw, J., Pislaru, S. V., Munger, T. M., & Holmes, D. R. (2017) · EuroIntervention · doi:10.4244/eij-d-17-00469 · Cited by 68
Patent Foramen Ovale Closure: State of the Art
Giblett, J. P., Williams, L. K., Kyranis, S. J., Shapiro, L. M., & Calvert, P. A. (2020) · Interventional Cardiology Reviews Research Resources · doi:10.15420/icr.2019.27 · Cited by 65
“In 90% of patients with non-valvular AF, the thrombus was located in the left atrial appendage.(54) The presence of AF in the context of a stroke is an indication for anticoagulation, and closure of a PFO is not indicated.”
Korhonen, M., Muuronen, A., Arponen, O., Mustonen, P. E., Hedman, M., Jäkälä, P., Vanninen, R. L., & Taina, M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0118822 · Cited by 69
“Over 90% of the intracardiac thrombi in patients with cardioembolic stroke/TIA originally develop in the LAA [3].”
BackgroundKim, R., Baumgartner, N. E., & Clements, J. M. (2012) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2012.10.016 · Cited by 65
Use of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Lesions
Biase, L. D. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.115.002776 · Cited by 66
“VHD, regardless of the disease type and severity, is associated with an increased risk of stroke,25 and the risk of thromboembolic events is further amplified in the presence of AF.26”
BackgroundInfluentialTzeis, 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) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-024-01771-5 · Cited by 66
Anatomy of the left atrium for interventional echocardiography
Ho, S. Y., McCarthy, K. P., & Faletra, F. F. (2011) · European Journal of Echocardiography · doi:10.1093/ejechocard/jer093 · Cited by 64
Fassini, G. M., Conti, S., Moltrasio, M., Maltagliati, A. C., Tundo, F., Riva, S. I., Russo, A. D., Casella, M., Majocchi, B., Zucchetti, M., et al. (2016) · EP Europace · doi:10.1093/europace/euw007 · Cited by 64
Thomas, M., Wu, L., & Win, K. (2014) · Journal of Biomedical Research · doi:10.7555/jbr.28.20130191 · Cited by 68
“4)) and mechanical procedures (resection/amputation either surgically([112-114]) or via video assisted thoracic surgery (VATS)([115]), surgical clipping (instead of suturing or stapling)([112]), percutaneous endocardial mechanical plugs (WATCHMAN([117]), AMPLATZER([118]), PLAATO([119])), or percutaneous epicardial sut…”
BackgroundResultPercutaneous left atrial appendage occlusion for stroke prevention in atrial fibrillation: an update
Backer, O. D., Arnous, S., Ihlemann, N., Vejlstrup, N. G., Jørgensen, E. O., Pehrson, S. M., Krieger, T., Meier, P., Søndergaard, L., & Franzen, O. W. (2014) · Open Heart · doi:10.1136/openhrt-2013-000020 · Cited by 64
“19 19 – 21 Undoubtedly, in patients with AF with comorbidities, embolic strokes can also develop from non-cardiac origins such as atheromatous plaque in the thoracic aorta or carotid arteries.”
BackgroundNedios, S., Kornej, J., Koutalas, E. P., Bertagnolli, L., Kosiuk, J., Rolf, S., Arya, A., Sommer, P., Husser, D., Hindricks, G., et al. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.08.016 · Cited by 63
Friedman, P. A., Asirvatham, S. J., Dalegrave, C., KINOSHITA, M., Danielsen, A. J., Johnson, S. B., Hodge, D. O., Munger, T. M., Packer, D. L., & Bruce, C. J. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2009.01465.x · Cited by 63
The left atrial appendage in humans: structure, physiology, and pathogenesis
Karim, N., Ho, S. Y., Nicol, E. D., Li, W., Zemrak, F., Markides, V., Reddy, V. Y., & Wong, T. (2019) · EP Europace · doi:10.1093/europace/euz212 · Cited by 62
Left atrial appendage exclusion: State‐of‐the‐art
Cruz‐González, I., Yan, B. P., & Lam, Y. (2009) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.22344 · Cited by 61
“In a review of 23 studies in which the LAA was examined by autopsy, transesophageal echocardiography (TEE) or direct intra-operative inspection, intracardiac thrombus was identified in 13% of cases of nonvalvular AF, of which 90% was located in the LAA [3].”
BackgroundGuideline for the surgical treatment of atrial fibrillation
Dunning, J., Nagendran, M., Alfieri, O., Elia, S., Kappetein, A. P., Lockowandt, U., Sarris, G. E., Kolh, P. H., Maruthappu, M., Nicholas, S., et al. (2013) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezt413 · Cited by 61
“First, with regard to the LAA as the source of emboli, studies have concluded that 90% of LA thrombi are located in the LAA [99], although this same study demonstrated it in only 50% of rheumatic patients.”
Pellegrino, P. L., Fassini, G. M., Biase, M. D., & Tondo, C. (2016) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12960 · Cited by 60
Ellis, C. R., Aznaurov, S. G., Patel, N., Williams, J. R., Sandler, K. L., Hoff, S. J., Ball, S. K., Whalen, S. P., & Carr, J. J. (2017) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2017.03.008 · Cited by 63
“Observation of a lower than expected stroke rate after open chest surgery with concomitant LAA ligation formed the scientific rationale that obliteration of the LAA could potentially reduce AF-related embolic stroke (1).”
BackgroundKubo, S., Mizutani, Y., Meemook, K., Nakajima, Y., Hussaini, A., & Kar, S. (2017) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2017.05.006 · Cited by 60
“The left atrial appendage (LAA) is the primary source (>90%) of thromboembolism in nonvalvular AF (2,3).”
BackgroundPatient-specific design of a soft occluder for the left atrial appendage
Robinson, S. S., Alaie, S., Sidoti, H., Augé, J., Baskaran, L., Avilés-Fernández, K., Hollenberg, S., Shepherd, R. F., Min, J. K., Dunham, S. N., et al. (2017) · Nature Biomedical Engineering · doi:10.1038/s41551-017-0180-z · Cited by 60
Camm, A. J., Savelieva, I., Ho, S. Y., Lindsay, B. D., Nattel, S., & Shinagawa, K. (2009) · Elsevier eBooks · doi:10.1016/b978-1-4377-0285-9.00044-2 · Cited by 60
The role of echocardiography in percutaneous left atrial appendage occlusion
Chue, C. D., Giovanni, J. D., & Steeds, R. P. (2011) · European Journal of Echocardiography · doi:10.1093/ejechocard/jer090 · Cited by 59
Feasibility of Left Atrial Appendage Occlusion in Left Atrial Appendage Thrombus
Sharma, S. P., Cheng, J., Turagam, M. K., Gopinathannair, R., Horton, R., Lam, Y., Tarantini, G., D’Amico, G., Freixa, X., Lange, M., et al. (2020) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2019.11.017 · Cited by 58
Stroke prevention strategies in high-risk patients with atrial fibrillation
Kotalczyk, A., Mazurek, M., Kalarus, Z. F., Potpara, T., & Lip, G. Y. H. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-00459-3 · Cited by 60
Thrombogenic and Arrhythmogenic Roles of the Left Atrial Appendage in Atrial Fibrillation
Biase, L. D., Natale, A., & Romero, J. E. (2018) · Circulation · doi:10.1161/circulationaha.118.034187 · Cited by 57
Fibrosis, atrial fibrillation and stroke: clinical updates and emerging mechanistic models
Boyle, P. M., del Álamo, J. C., & AKOUM, N. W. (2020) · Heart · doi:10.1136/heartjnl-2020-317455 · Cited by 59
Clinical Implications of Leaks Following Left Atrial Appendage Ligation With the LARIAT Device
Gianni, C., Biase, L. D., Trivedi, C. G., Mohanty, S., Gökoğlan, Y., Günes, M. F., Bai, R., Al‐Ahmad, A., Burkhardt, J. D., Horton, R., et al. (2016) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2016.01.038 · Cited by 56
Möbius‐Winkler, S. (2015) · World Journal of Cardiology · doi:10.4330/wjc.v7.i2.65 · Cited by 56
Tarantini, G., D’Amico, G., Latib, A., Montorfano, M., Mazzone, P., Fassini, G. M., Maltagliati, A. C., Ronco, F., Saccà, S., Cruz‐González, I., et al. (2018) · EuroIntervention · doi:10.4244/eij-d-17-00777 · Cited by 56
Cardiovascular Therapies Targeting Left Atrial Appendage
Turagam, M. K., Velagapudi, P., Kar, S., Holmes, D. R., Reddy, V. Y., Refaat, M. M., Biase, L. D., Al‐Ahmed, A., Chung, M. K., Lewalter, T., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.05.048 · Cited by 56
“The left atrial appendage (LAA) is the most common source of thrombus in patients with AF who have experienced a stroke (4,5).”
BackgroundLeft Atrial Appendage Exclusion and the Risk of Thromboembolic Events Following Mitral Valve Surgery
Almahameed, S., Khan, M., Zuzek, R. W., Juratli, N., Belden, W. A., Asher, C. R., Novaro, G. M., Martin, D. O., & Natale, A. (2007) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2006.00755.x · Cited by 56
Wudel, J. H., Chaudhuri, P., & Hiller, J. J. (2007) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2007.08.014 · Cited by 55
The use of imaging in new transcatheter interventions: an EACVI review paper
Zamorano, J. L., Gonçalves, A., Lancellotti, P., Andersen, K. A., González-Gómez, A., Monaghan, M. J., Brochet, É., Wunderlich, N. C., Gafoor, S. A., Gillam, L. D., et al. (2016) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jew043 · Cited by 54
Landmesser, U., Skurk, C., Tzikas, A., Falk, V., Reddy, V. Y., & Windecker, S. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae398 · Cited by 56
“6–9 Efforts to improve stroke prevention in patients with AF are therefore of paramount clinical importance.”
Background
Metadata
- 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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