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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“Approximately 47% of thrombi in valvular AF (mostly mitral stenosis) and 91% of those in non-valvular AF are located in the left atrial appendage (LAA) [3].”
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“The association between clinical events (CVA or TIA, atrial fibrillation, and palpitations) and LAAA were described using odds ratios (OR) and 95% confidence intervals (CI).”
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Smith, N., Joseph, J., Morgan, J., & Masroor, S. (2017) · Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery · doi:10.1097/imi.0000000000000339 · Cited by 13
“It is well known that up to 90% of emboli in patients with nonvalvular AF originate in the left atrial appendage (LAA).(2) Since the 1940s, surgeons, cardiologists, and other medical specialists have been studying methods of decreasing that risk by anticoagulation or isolation of the LAA.”
BackgroundLong-Term Risk of Ischemic Stroke After the Cox-Maze III Procedure for Atrial Fibrillation
Albåge, A., Sartipy, U., Kennebäck, G., Johansson, B., Scherstén, H., Jidéus, L., Albåge, A., Jidéus, L., Kennebäck, G., Källner, G., et al. (2017) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2016.11.065 · Cited by 14
“In one review, LA thrombus was found in 17% of nonvalvular AF patients, and 91% of these clots were found in the LAA [21].”
BackgroundLeft atrial appendage occlusion for stroke prevention in patients with atrial fibrillation
Bajwa, R. J., Kovell, L. C., Resar, J. R., Arbab‐Zadeh, A., Mandal, K., Calkins, H. G., & Berger, R. D. (2017) · Clinical Cardiology · doi:10.1002/clc.22764 · Cited by 13
“In nonvalvular AF patients, up to 91% of left atrial (LA) thrombi have been localized to the left atrial appendage (LAA).(5,6) The LAA has a narrow orifice with a trabeculated structure that predisposes to blood stasis and thrombus formation.”
BackgroundZheng, Y., Rao, C., Chen, S., He, L., Hou, J., & Zheng, Z. (2020) · Chinese Medical Journal · doi:10.1097/cm9.0000000000000967 · Cited by 13
“Studies report that the left atrial appendage (LAA) plays a role in thrombus formation, and is considered the source of 90% of the embolisms in non-valvular atrial fibrillation and 57% of the embolisms in valvular atrial fibrillation.([2,3]) Furthermore, atrial fibrillation is associated with an estimated three- to fi…”
BackgroundAjmal, M., Sipra, Q. U. A. R., Pecci, C., Iqbal, N., & Rathore, S. (2020) · Journal of Interventional Cardiology · doi:10.1155/2020/1575839 · Cited by 13
“*erefore, mechanical left atrial appendage occlusion (LAAO) is a novel therapeutic modality used to reduce the risk of atrial thromboembolism in patients with nonvalvular atrial fibrillation (AF) and increased risk of bleeding [3, 4].”
BackgroundYoshimoto, A., Suematsu, Y., Kurahashi, K., Kaneko, H., Arima, D., & Nishi, S. (2020) · Annals of Thoracic and Cardiovascular Surgery · doi:10.5761/atcs.oa.20-00204 · Cited by 13
Gwak, D.-S., Choi, W., Kim, Y.-W., Kim, Y., & Hwang, Y. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.679320 · Cited by 13
“LAA is a major source of thrombus in patients with AF (17), and, compared with CW morphology, non-CW LAA morphology is related to embolic events (14, 18).”
BackgroundLeft Atrial Appendage Morphology Impacts Thrombus Formation Risks in Multi-Physics Atrial Models
Qureshi, A., Balmus, M., Nechipurenko, D. Y., Иноятович, А. Ф., Williams, S. E., Lip, G. Y. H., Nordsletten, D., Aslanidi, O. V., & de Vecchi, A. (2021) · Computing in cardiology · doi:10.23919/cinc53138.2021.9662901 · Cited by 13
“Greater than 91% of AF-related thrombi originate from the left atrial appendage (LAA) which is a muscular extension to the left atrium (LA) [3].”
BackgroundA systematic review of the use of 3D printing in left atrial appendage occlusion procedures
Tarabanis, C., Klapholz, J., Zahid, S., & Jankelson, L. (2022) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15658 · Cited by 13
“Evidence from echocardiography and autopsy studies showing that up to 90% of left atrial thrombi localized to the left atrial appendage (LAA) illustrated the potential of this anatomical structure in AF stroke prevention.(1) The subsequent advent of left atrial appendage occlusion (LAAO) devices provided a nonpharmaco…”
BackgroundReddy, V. G., Rajasekhar, D., & Vanajakshamma, V. (2012) · Indian Heart Journal · doi:10.1016/j.ihj.2012.07.008 · Cited by 13
“In the past, the left atrial appendage (LAA) has been considered to be a relatively useless part of cardiac anatomy, but is now recognized as a structure with important pathological implications.(1) LAA normally prevents stasis of blood due to it’s high compliance and contractility.”
BackgroundStroke prevention in atrial fibrillation: WATCHMAN versus warfarin
Holmes, D. R., & Fountain, R. B. (2009) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.09.64 · Cited by 13
Leal, S., Moreno, R., Almeida, M., Silva, J. A., & López-Sendón, J. L. (2012) · Current Cardiology Reviews · doi:10.2174/157340312801215827 · Cited by 13
“Left atrial appendage (LAA), a remnant of the embryonic left atrium, was demonstrated in echocardiographic and autopsy studies to be the source of thrombi in more than 90% of patients with nonvalvular AF [7-9].”
BackgroundAnatomical basis of minimally invasive epicardial ablation of atrial fibrillation
Gelsomino, S., Corradi, D., Lorusso, R., Parise, O., Callegari, S., Macchi, E., Maessen, J. G., & Meir, M. L. (2012) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezs550 · Cited by 13
“Indeed, it has been reported that 90% of patients with non-rheumatic AF thrombi were located in the LAA, and this structure is of extreme importance for stroke prophylaxis [56].”
BackgroundOff-pump myocardial revascularization
DeSimone, J., & Sergeant, P. (2006) · Multimedia Manual of Cardio-Thoracic Surgery · doi:10.1510/mmcts.2004.000539 · Cited by 13
Feasibility of LAA Closure for Left Atrial Thrombus in Patients With Aortic Stenosis and AF
Parashar, A., Sud, K., Devgun, J. K., Agarwal, S., Bassi, M., Tuzcu, E. M., Griffin, B. P., Krishnaswamy, A., & Kapadia, S. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.05.069 · Cited by 13
“This is in contrast with AF related to rheumatic mitral valve disease where in about 57% of atrial thrombus are present or extend into the left atrial cavity (4).”
ResultChen, Y., Zhang, Y., Huang, W., HUANG, K., Xu, B., & Su, X. (2017) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13020 · Cited by 13
Innovative Cardiac Devices on Chest Imaging
Brixey, A. G., & Fuss, C. (2017) · Journal of Thoracic Imaging · doi:10.1097/rti.0000000000000304 · Cited by 13
Willits, I., Keltie, K., Linker, N. J., de Belder, M., Henderson, R. A., Patrick, H. E., Powell, H., Berry, L., Urwin, S., Cole, H., et al. (2021) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcab042 · Cited by 13
“In approximately 90% of strokes in people with AF, the origin of the thromboembolism is the left atrial appendage.(12) Left atrial appendage occlusion (LAAO) is a non-pharmacological intervention that aims to reduce the risk of thromboembolic stroke in patients with AF by mechanically blocking the entrance to the appe…”
BackgroundPrevention of stroke by percutaneous left atrial appendage closure: Short term follow-up
Meester, P. D., Thijs, V., Deyk, K. V., & Budts, W. (2008) · International Journal of Cardiology · doi:10.1016/j.ijcard.2008.11.112 · Cited by 13
Reddy, V. Y., Hylek, E. M., Camm, A. J., Halperin, J. L., Diener, H., Thaler, D., Schmidt, B., Hara, H., Huisman, M. V., Price, M. J., et al. (2026) · American Heart Journal · doi:10.1016/j.ahj.2026.107367 · Cited by 12
Fukuda, N., Imamura, T., Tanaka, S., Kataoka, N., Ushijima, R., Ueno, H., & Kinugawa, K. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11061618 · Cited by 12
“The existence of non-valvular atrial fibrillation (NVAF) increases the risk of cardiogenic embolisms, most of which occur from the left atrial appendage [1,2].”
BackgroundZhang, S., Cui, Y., Li, J., Tian, H., Yun, Y., Zhou, X., Fang, H., Zhang, H., Zou, C., & Ma, X. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.970847 · Cited by 12
“In addition, surgical LAA clipping might provide an “electrical isolation” effect, thereby potentially reducing the stroke risk (11).”
BackgroundLitwinowicz, R. A., Natorska, J., Ząbczyk, M., Kapelak, B., Lee, R. J., Vuddanda, V. L. K., Lakkireddy, D., & Bartuś, K. (2022) · Journal of Thoracic Disease · doi:10.21037/jtd-21-1093 · Cited by 13
“In nonvalvular AF patients, 90% of thrombi are located in the LAA, as confirmed by autopsy, transesophageal echocardiography, or direct inspection studies (16).”
Left atrial appendage amputation concomitant with cardiac surgery in patients with sinus rhythm
Gerçek, M., Börgermann, J., Gerçek, M., & Gummert, J. F. (2023) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezad088 · Cited by 12
Fiore, G., Gaspardone, C., Ingallina, G., Rizza, V., Melillo, F., Stella, S., Ancona, F., Biondi, F., Margonato, D., Palmisano, A., et al. (2023) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2023.05.013 · Cited by 12
Hu, T., Chen, T., Maduray, K., Han, W., & Zhong, J. (2024) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2506191 · Cited by 12
“Previous studies have suggested that the LAA is the primary source of thrombus in patients with non-valvular AF [ 53].”
Non-Surgical Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation
Friedman, P. A., & Holmes, D. R. (2011) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2011.02172.x · Cited by 12
Nonpharmacologic Approaches to Stroke Prevention in Atrial Fibrillation
Whitlock, R. P., Hanif, H., & Danter, M. R. (2013) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2013.04.004 · Cited by 12
Cardiac Procedures to Prevent Stroke: Patent Foramen Ovale Closure/Left Atrial Appendage Occlusion
Freixa, X., Arzamendi, D., Tzikas, A., Noble, S., Basmadjian, A., Garceau, P., & Ibrahim, R. (2013) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2013.11.008 · Cited by 12
Faustino, A., Paiva, L., Providencia, R. A., Trigo, J., Botelho, A., Costa, M. A. D. S., & Leitão‐Marques, A. (2013) · Revista Portuguesa de Cardiologia (English Edition) · doi:10.1016/j.repce.2013.06.001 · Cited by 12
Transcatheter left atrial appendage exclusion, gold or fool's gold?
Khattab, A. A., & Meier, B. (2010) · European Heart Journal Supplements · doi:10.1093/eurheartj/suq008 · Cited by 12
“Second, the backward-bent hooks on the lobe afford active fixation of the device in the LAA.”
BackgroundInfluentialSCAI/ACC/HRS institutional and operator requirements for left atrial appendage occlusion
Kavinsky, C. J., Kusumoto, F. M., Bavry, A. A., Bailey, S. R., Ellenbogen, K. A., Hess, P. L., Lustgarten, D. L., Moussa, I. D., & Spies, C. (2015) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.26381 · Cited by 12
“The observation that greater than 90% of thrombi identified in patients with non-valvular AF are found in the LAA has led to the development of mechanical approaches to closing the LAA orifice [21].”
Brzeziński, M., Bury, K., Dąbrowski, L., HOLAK, P., Sejda, A., Pawlak, M. M., Jagielak, D., Adamiak, Z., & Rogowski, J. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0154559 · Cited by 12
“More than 90% of atrial clots in non-rheumatic atrial fibrillation cases form in the LAA[5]; therefore, LAA exclusion can reduce the incidence of clot formation and, thus, the risk of stroke.”
Juo, Y., Bailey, K. L., Seo, Y., Aguayo, E., & Benharash, P. (2018) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2018.02.089 · Cited by 12
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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