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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“However, it must be remembered that in patients with AF associated with rheumatic mitral valve disease, stroke may result from thrombus in the body of the left atrium itself.(12) Obviously, in these latter patients, local LAA therapy would not substantially decrease stroke rates.”
BackgroundPercutaneous devices for left atrial appendage occlusion: A contemporary review
Pacha, H. M., Al‐Khadra, Y., Soud, M., Darmoch, F., Pacha, A. M., & Alraies, M. C. (2019) · World Journal of Cardiology · doi:10.4330/wjc.v11.i2.57 · Cited by 33
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“Surgical closure of the LAA has been practised since 1948, primarily in patients with mitral valve disease [5].”
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“Exclusion of the left atrial appendage (LAA) might be considered an alternative to OAC, supported by the rationale that the LAA is the principal source of thrombi in patients with NVAF.(9) The current European Society of Cardiology (ESC) guidelines recommend considering percutaneous occlusion of the LAA for patients c…”
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“A multivariable analysis of clinical cohorts followed prospectively in clinical trials and other care settings revealed that thrombi have been identified using transesophageal echocardiography (TEE) in 15–20% of patients with AF who have clinical risk factors for ischemic stroke”
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UV‐Triggered Hydrogel Coating of the Double Network Polyelectrolytes for Enhanced Endothelialization
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Left atrial appendage segmentation from 3D CCTA images for occluder placement procedure
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“It is thought that at least 90% of thrombi in patients with AF originate in the left atrial appendage [6].”
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Hernández‐Estefanía, R., Praschker, B. L., Bastarrika, G., & Rábago, G. (2011) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2011.05.022 · Cited by 30
“It has been observed that up to 90% of clots in patients with AF are located in the LAA [1], and it increases the risk of stroke [2] threefold.”
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“As shown in Figure 1, it is self-expanded and consists of: (1) 8- to 10-Fr delivery sheath (delivery system), (2) hook-embedded umbrella, and (3) size selective cover.”
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“Principal source of thromboembolism is localized to the left atrial appendage (LAA) in 91% of patients with LAF as compared to 57% of patients with associated rheumatic disease [13].”
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Edgerton, J. R. (2018) · Journal of Atrial Fibrillation · doi:10.4022/jafib.1642 · Cited by 29
“In patients with nonvalvular AF, the most common site for thrombus formation is the left atrial appendage (LAA), which accounts for >90% of detected thrombi[5],[6].”
Masjuán, J., Tahoces, L. S., DeFelipe, A., Hernández‐Antolín, R., Fernández‐Golfín, C., Cruz‐Culebras, A., Matute, C., Vera, R., Pérez‐Torre, P., & Zamorano, J. L. (2018) · European Journal of Neurology · doi:10.1111/ene.13894 · Cited by 29
“Although it is commonly accepted that 90% of the thrombi originate in the LAA [16], the fact remains that its closure does not completely eliminate the risk of a new stroke.”
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Schrag, M., Grory, B. M., Nackenoff, A. G., Eaton, J. E., Mistry, E. A., Kirshner, H. S., Yaghi, S. R., & Ellis, C. R. (2020) · Translational Stroke Research · doi:10.1007/s12975-020-00838-5 · Cited by 31
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“The risk of stroke may also be associated with the morphological features of the LAA (29).”
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“However, evidence from surgical studies suggests that in most of these patients, they originate in the LAA [13].”
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“An alternative treatment strategy in such patients is percutaneous device-based occlusion of the LAA, from where 90% of thrombi are thought to originate.(13)”
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“As many as 90% of patients with nonrheumatic AF have been reported to have thrombi in their left atrium.(2) LAA is also a potential electric substrate for induction of AF, and so its removal or electric isolation reduces the risk of AF relapse/continuation.”
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Surgical clip closure of the left atrial appendage
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“Transesophageal echocardiography (TOE) is used to assess the preprocedural presence of thrombus in the LAA.”
BackgroundInfluentialLeft Atrial Appendage Closure –The WATCHMAN Device
Akinapelli, A., Bansal, O., Chen, J. P., Pflugfelder, A., Gordon, N. T., Steín, K. M., Huibregtse, B. A., & Hou, D. (2015) · Current Cardiology Reviews · doi:10.2174/1573403x11666150805115822 · Cited by 28
“found that in AF patients with intracardiac thrombi, 90% of the thrombi originated in the LAA [8].”
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“In patients with nonrheumatic AF, approximately 90% of thrombi in the left atrium originate in the LAA.(4,5) The efficacy of anticoagulation treatment in reducing the risk of thromboembolic events has been documented in randomized controlled studies.”
BackgroundInfluentialComplications From Left Atrial Appendage Exclusion Devices.
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Transcatheter occlusion of the left atrial appendage for stroke prevention
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“results in a low atrial flow, significantly increasing the risk of atrial thrombi, which, besides, are often located in various regions of the atria but the left atrial appendage (91% in NVAF and 57% in AF associated with mitral stenosis).(14) Since the thrombo-embolic risk is increased, and the efficacy of new antico…”
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“Study exclusion criteria included: unfavorable anatomy that would prevent LAAC including (1) prior atrial septal defect, patent foramen ovale, LAA ligation or prior implanted closure device; (2) a history of unprovoked deep vein thrombosis or pulmonary embolism, or mechanical heart valve mandating OAC; (3) rheumatic h…”
BackgroundMethodInfluentialSCAI/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) · Journal of the Society for Cardiovascular Angiography & Interventions · doi:10.1016/j.jscai.2022.100577 · Cited by 27
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“During AF, most clots are thought to form in the left atrial appendage (14).”
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“, during mitral valve surgery or maze procedures (series of incisions arranged in a maze-like pattern in the atria).(5) While the feasibility of surgical LAAO has been investigated,(14,15) it has not been clarified whether the frequent incompleteness of LAAO during other cardiac surgery procedures does not ultimately…”
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“Among patients with AF, 90% of strokes can be attributed to thrombi originating from the left atrial appendage (LAA).(6) Concomitant surgical LAA management is recommended both by the revised 2019 American College Cardiology (Class IIB)(7) and 2017 Society of Thoracic Surgeons (Class IIA)(8) guidelines.”
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“The major origin of thrombus formation in patients with AF is the left atrial appendage (LAA) [3].”
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Lam, Y., Ma, T. K. W., & Yan, B. P. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2010.10.017 · Cited by 26
Gloekler, S., Saw, J., Koskinas, K. C., Kleinecke, C., Jung, W., Nietlispach, F., & Meier, B. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.08.049 · Cited by 26
Alkhouli, M. A., Chaker, Z., Clemetson, E., Alqahtani, F., Hajji, M. A., Lobban, J. H., Sengupta, P. P., & Raybuck, B. D. (2019) · Structural Heart · doi:10.1080/24748706.2019.1663381 · Cited by 26
“The LAA is the nidus for thrombus formation in >90% of patients with AF.10 Hence, the goal of effective LAA exclusion techniques is to provide safe and complete closure of the LAA to reduce the risk of thromboembolic stroke.”
BackgroundTeíger, E., Thambo, J., Defaye, P., Hermida, J., Abbey, S., Klug, D., Juliard, J., Pasquié, J., Rioufol, G., Lepillier, A., et al. (2018) · Circulation Cardiovascular Interventions · doi:10.1161/circinterventions.117.005841 · Cited by 26
Reinhardt, S. W., Gibson, D. N., Hsu, J. C., Kapadia, S. R., Yeh, R. W., Price, M. J., Piccini, J. P., Nair, D. G., Christen, T., Allocco, D. J., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.05.067 · Cited by 25
Qureshi, A., Melidoro, P., Balmus, M., Lip, G. Y. H., Nordsletten, D., Williams, S. E., Aslanidi, O. V., & de Vecchi, A. (2025) · Medical Image Analysis · doi:10.1016/j.media.2025.103475 · Cited by 25
Munkholm-Larsen, S., Cao, C. Q., Yan, T. D., Pehrson, S. M., & Dixen, U. (2012) · Heart · doi:10.1136/heartjnl-2011-301256 · Cited by 25
Left Atrial Appendages Occlusion: Current Status and Prospective
Sharma, S. P., Park, P., & Lakkireddy, D. (2018) · Korean Circulation Journal · doi:10.4070/kcj.2018.0231 · Cited by 25
Bang, O. Y., Park, K., & Jeong, D. S. (2023) · Journal of Stroke · doi:10.5853/jos.2022.03552 · Cited by 25
“After deployment, it produces a constant compression pressure, ensuring the complete exclusion of the LAA.”
BackgroundBoucebci, S., Pambrun, T., Velasco, S., Duboé, P.-O., Ingrand, P., & Tasu, J. (2015) · European Radiology · doi:10.1007/s00330-015-3962-2 · Cited by 25
Left Atrial Appendage Occlusion for Stroke Prevention
Alli, O. O., & Holmes, D. R. (2015) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2015.06.005 · Cited by 25
Mohrs, O. K., Wunderlich, N. C., Petersen, S. E., Pottmeyer, A., & Kauczor, H. (2011) · Journal of Cardiovascular Magnetic Resonance · doi:10.1186/1532-429x-13-33 · Cited by 25
“Anticoagulation is required to prevent further cerebral events as patients in atrial fibrillation have a 5-fold higher risk of embolic stroke than those in sinus rhythm [3-5].”
BackgroundZapolanski, A., Johnson, C. K., Dardashti, O., OʼKeefe, R., Rioux, N., Ferrari, G. M., Shaw, R. E., Brizzio, M. E., & Grau, J. B. (2013) · Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery · doi:10.1097/imi.0000000000000022 · Cited by 25
Leithäuser, B., & Park, J. (2009) · Korean Circulation Journal · doi:10.4070/kcj.2009.39.11.443 · Cited by 27
Undas, A. (2019) · EP Europace · doi:10.1093/europace/euz271 · Cited by 24
Left atrial appendage closure – Current status and future directions
Alfadhel, M., Nestelberger, T., Samuel, R., McAlister, C., & Saw, J. (2021) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2021.11.013 · Cited by 24
Surgical options for treatment of atrial fibrillation.
Meir, M. L. (2014) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2225-319x.2014.01.07 · Cited by 24
“It is assumed that 90% of clinically apparent embolisms in patients with AF originate from the LAA (58).”
BackgroundGadiyaram, V. K., Mohanty, S., Gianni, C., Trivedi, C. G., Al‐Ahmad, A., BURKHARDT, D. J., Gallinghouse, J. G., Hranitzky, P. M., Horton, R., Sánchez, J., et al. (2019) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13838 · Cited by 24
Strange, J. E., Sindet‐Pedersen, C., Stærk, L., Grove, E. L., Gerds, T. A., Torp-Pedersen, C. T., Gislason, G., & Olesen, J. B. (2020) · European Heart Journal - Cardiovascular Pharmacotherapy · doi:10.1093/ehjcvp/pvaa011 · Cited by 24
“The version of record [Jarl E Strange, MB, Caroline Sindet-Pedersen, MSc, PhD, Laila Staerk, MD, PhD, Erik L Grove, MD, PhD, Thomas Alexander Gerds, dr. rer nat, Christian Torp-Pedersen, MD, DMSc, Gunnar H Gislason, MD, PhD, Jonas Bjerring Olesen, MD, PhD, All-cause mortality, stroke, and bleeding in patients with atr…”
BackgroundInfluentialImpact of left atrial appendage exclusion on left atrial function
Kamohara, K., Popović, Z., Daimon, M., Martin, M. G., Ootaki, Y., Akiyama, M., Zahr, F. E., Cíngöz, F., Ootaki, C., Kopcak, M. W., et al. (2006) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2006.08.057 · Cited by 24
The Left Atrial Appendage and Atrial Fibrillation—A Contemporary Review
Sulague, R. M., Whitham, T., Danganan, L. M. L., Effiom, V. B., Candelario, K., Latif, N., & Hameed, I. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12216909 · Cited by 23
“The left atrial appendage poses significant risk for thromboembolism in patients with atrial fibrillation [49].”
BackgroundLeft Atrial Appendage Closure in Atrial Fibrillation: A World without Anticoagulation?
Contractor, T. A., & Khasnis, A. A. (2011) · Cardiology Research and Practice · doi:10.4061/2011/752808 · Cited by 23
“(i) Hypothesis is based on a landmark study by Blackshear and Odell [31]”
BackgroundAtrial fibrillation in heart failure: The sword of Damocles revisited.
Khan, M., Ahmed, F., Neyses, L., & Mamas, M. (2013) · World Journal of Cardiology · doi:10.4330/wjc.v5.i7.215 · Cited by 21
Characterization of Cerebrovascular Events After Left Atrial Appendage Occlusion
Freixa, X., Llull, L., Gafoor, S. A., Cruz‐González, I., Shakir, S., Omran, H., Berti, S. L., Santoro, G., Kefer, J., Landmesser, U., et al. (2016) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2016.08.075 · Cited by 23
Jhand, A., Thandra, A., Gwon, Y., Turagam, M. K., Ashwath, M. L., Yadav, P., Alenezi, F. A. M., Garg, J., Abbott, J. D., Lakkireddy, D., et al. (2020) · Europe PMC (PubMed Central) · Cited by 23
Turagam, M. K., Neužil, P., Hála, P., Mráz, T., Dukkipati, S. R., & Reddy, V. Y. (2021) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2021.10.001 · Cited by 23
Interventional Closure of the Left Atrial Appendage for Stroke Prevention
Matsuo, Y., Sandri, M., Mangner, N., Majunke, N., Dähnert, I., Schuler, G. C., Kurabayashi, M., & Möbius‐Winkler, S. (2014) · Circulation Journal · doi:10.1253/circj.cj-13-0828 · Cited by 23
Makhija, Z., Allen, M. S., Wigle, D. A., Shen, K. R., Cassivi, S. D., Nichols, F. C., & Deschamps, C. C. (2011) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2011.04.066 · Cited by 23
“Whether other options that do not involve anticoagulation, such as left atrial appendage ligation or implantation of devices, such as the Watchman device (Atritech Inc, Plymouth, MN), will be effective is currently unknown [20, 21].”
BackgroundLeft Atrial Appendage Exclusion for Atrial Fibrillation
Syed, F. F., DeSimone, C. V., Friedman, P. A., & Asirvatham, S. J. (2014) · Cardiology Clinics · doi:10.1016/j.ccl.2014.07.006 · Cited by 23
“2 and 3).(2,5) Given that warfarin does not significantly affect atheroembolic or arterial occlusive disease, and yet it dramatically reduces stroke in AF, it is reasonable to expect that an LAA occlusion strategy prevents most warfarin-sensitive strokes in AF.”
Percutaneous left atrial appendage occlusion: Effect of device positioning on outcome
Wolfrum, M., Attinger‐Toller, A., Shakir, S., Gloekler, S., Seifert, B., Moschovitis, A., Khattab, A. A., Maisano, F., Meier, B., & Nietlispach, F. (2016) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.26646 · Cited by 23
“Patients Patients with NVAF and indications for long-term OAC (CHA2DS2-Vasc score 1) who underwent LAAO at the University Hospital of Bern were included in the present study.”
BackgroundInfluentialBellmann, B., Schnupp, S., Kühnlein, P., JAVERNIK, C., Kleinecke, C., Rillig, A., Landmesser, U., Brachmann, J., & Park, J. (2016) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13141 · Cited by 23
Surgical management of the left atrial appendage: a must or a myth?
Hanke, T. (2018) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezy088 · Cited by 23
“In a meta-analysis by Blackshear and Odell [17], the risk of stroke was reduced by up to 65% in patients with AF compared to placebo.”
Dieker, W., Behnes, M., Fastner, C., Sartorius, B., Wenke, A., Sing-Gill, I., El‐Battrawy, I., Kuschyk, J., Papavassiliu, T., Hoffmann, U., et al. (2018) · Scientific Reports · doi:10.1038/s41598-018-19385-z · Cited by 23
Lindner, S., Behnes, M., Wenke, A., Sartorius, B., Ansari, U., Akin, M., Mashayekhi, K., Vogler, N., Haubenreisser, H., Schoenberg, S. O., et al. (2018) · International journal of cardiac imaging · doi:10.1007/s10554-018-1493-z · Cited by 23
Aonuma, K., Yamasaki, H., Nakamura, M., Matsumoto, T., Takayama, M., Andò, K., Hirao, K., Goya, M., Morino, Y., Hayashida, K., et al. (2020) · Circulation Journal · doi:10.1253/circj.cj-20-0196 · Cited by 23
“There were 3 co-primary endpoints in this trial: (1) periprocedural safety defined as acute events within 7 days of the procedure (major CV or endovascular complications); (JCS)/Japanese Heart Rhythm Society (JHRS) Guideline on nonpharmacotherapy of cardiac arrhythmias.”
BackgroundBanga, S., Osman, M., Sengupta, P. P., Benjamin, M. M., Shrestha, S., Challa, A., Zeb, I., Kadiyala, M., Mills, J., Balla, S., et al. (2020) · Journal of cardiovascular computed tomography · doi:10.1016/j.jcct.2020.12.003 · Cited by 23
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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