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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“Since 90% of thrombi caused by AF can occur in the LAA [10], the importance of an interventional approach to the LAA has been considered.”
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“Most of the thrombi responsible for these ischemic events originate in the left atrial appendage (LAA) [2].”
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Yingchoncharoen, T., Jha, S. K., Burchill, L. J., & Klein, A. L. (2014) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2013.11.006 · Cited by 11
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“The mechanism of thrombosis formation is stasis of blood in the left atrium, and it is currently thought that a high percentage of thromboemboli develop in the left atrial appendage (LAA).(3,4) Given the high prevalence of AF, along with the potential risks and inconvenience of long-term (LT) OAC therapy, there is a g…”
BackgroundLeft atrial appendage occlusion: A better alternative to anticoagulation?
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Yarlagadda, B., Parikh, V. K., Dar, T. A., & Lakkireddy, D. (2017) · Journal of Atrial Fibrillation · doi:10.4022/jafib.1725 · Cited by 11
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“Ninety percent of thrombi, in the setting of non-valvular atrial fibrillation, are found in left atrial appendage [3] and around 27% of patients presenting for repeat ablation procedures have triggers in left atrial appendage [4].”
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Percutaneous left atrial appendage occlusion
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“The trabecular LAA is the remnant of the embryonic left atrium and is implicated in the site for thrombogenesis in more than 90% cases [5] in transesophageal echocardiogram studies.”
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“[3] A “windsock” morphology of the LAA was twice as common in the incomplete coverage group.”
BackgroundNew perspective on the risk markers for left atrial thrombosis in patients with atrial fibrillation
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“As the majority of thrombi in patients with AF are thought to come from the LAA [34], different devices for LAAO have been designed.”
BackgroundLeft Atrial Appendage Closure During Coronary Bypass Surgery in Patients on Hemodialysis
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Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives
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“The aim of LAAC is to exclude from circulation the left atrial appendage (LAA), which is the main source of cardiac thrombi in patients with non-valvular atrial fibrillation [4].”
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Gosvig, K., Goller, J., Hansson, N. H., Brandes, A., Modrau, I. S., Rasmussen, L. F., Eskesen, K., Jensen, A. K. G., Belley‐Côté, E. P., Whitlock, R. P., et al. (2025) · American Heart Journal · doi:10.1016/j.ahj.2025.04.015 · Cited by 10
Nearly all left atrial thrombi may be extended from pulmonary vein thrombi
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“Left atrial thrombus is a known cause of ischemic stroke [2,3]; however, the cause of left atrial thrombus remains unknown.”
BackgroundAtrial fibrillation part 1: pathophysiology
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“About 90% of strokes in cases of AF are found to have occurred from emboli from within the left atrial appendage (Blackshear and Odell, 1996).”
BackgroundInitial Experience with Total Thoracoscopic Ablation
Lee, H. M., Chung, S. R., & Jeong, D. S. (2014) · The Korean Journal of Thoracic and Cardiovascular Surgery · doi:10.5090/kjtcs.2014.47.1.1 · Cited by 10
“Besides its likely contribution to strokes, LAA is important because it is a driver of AF [14,15].”
BackgroundThe potential role of the left atrial septal pouch in cryptogenic stroke
Wong, J. M., & Fisher, M. (2015) · Expert Review of Cardiovascular Therapy · doi:10.1586/14779072.2015.1100536 · Cited by 10
“When a thrombus is found in the left atrium (LA) in a patient with nonvalvular AF, it is found in the LAA more than 90% of the time [7].”
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“[7‐9] In NVAF patients, more than 90% of atrial thrombus originate from the left atrial appendage (LAA).[10] Percutaneous closure of the LAA has been developed as an alternative to OAC for stroke prevention in NVAF patients, particularly in patients with contraindications to long‐term OAC.”
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“Transoesophageal echocardiography (TOE) data and surgical reports reveal that >90% of AF-related thrombi originate from the left atrial appendage (LAA).(2) Left atrial appendage closure is an emerging option in AF patients who are not eligible for oral anticoagulation therapy because of contraindications or high bleed…”
BackgroundMaarse, M., Wintgens, L. I. S., Ponomarenko, A., Phillips, K. P., Romanov, A. B., Ballesteros, G., Swaans, M. J., Folkeringa, R., García‐Bolao, I., & Boersma, L. V. A. (2021) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.14889 · Cited by 10
LIN, A. C., & Knight, B. P. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2015.07.009 · Cited by 10
Hwang, P. T. J., Sherwood, J. A., Millican, R. C., Bobba, P. S., Lynd, T. O., Garner, J. N., Brott, B. C., Hou, D., & Jun, H. (2021) · ACS Applied Bio Materials · doi:10.1021/acsabm.1c00202 · Cited by 10
Left atrial appendage occlusion device infection: Take it or leave it?
Madanat, L., Bloomingdale, R. J., Shah, K. B., Khalife, A., Haines, D. E., & Mehta, N. K. (2021) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2021.08.006 · Cited by 10
“However, alternative therapy may be advisable in a certain subset of patients, owing to either previous failure of oral anticoagulation or presence of contraindications to anticoagulation.1 The left atrial appendage has been identified as the primary site of thrombus formation in more than 90% of patients with AF.2 Th…”
BackgroundLeft atrial appendage exclusion in atrial fibrillation
Rozen, G., Margolis, G., Marai, I., Roguin, A., Rahamim, E., Planer, D., Heist, E. K., Amir, O., Tahiroglu, I., Ruskin, J. N., et al. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.949732 · Cited by 10
“In a review of 23 studies, when documented, thrombi were present in the LAA in 201 of 222 (91%) non-rheumatic AF patients and 254 of 446 (57%) patients with rheumatic AF (18).”
BackgroundJin, L.-S., Ke, J.-Y., Lin, Y.-N., Li, L., Fu, J.-Y., Chen, Y.-L., Qiu, Y.-X., Li, X., Pan, Y.-Q., & Li, Y. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.1071119 · Cited by 10
“Atrial fibrillation (AF) is the most prevalent arrhythmia with an increased risk of atrial thrombosis, which forms most commonly in the left atrial appendage (LAA) in patients with non-valvular AF (1).”
BackgroundMethodPinho, J., Dhaenens-Meyer, L. K. L., Heckelmann, J., Dafotakis, M., May, R., Wiesmann, M., Schulz, J. B., & Matz, O. (2022) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2022.106936 · Cited by 10
Baudo, M., Petruccelli, R. D., D’Alonzo, M., Rosati, F., Benussi, S., Bacco, L. D., & Muneretto, C. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.02.008 · Cited by 10
Cha, M. J., An, D.-G., Kang, M., Kim, H. M., Kim, S., Cho, I., Hong, J., Choi, H., Cho, J., Shin, S. Y., et al. (2023) · Korean Journal of Radiology · doi:10.3348/kjr.2023.0173 · Cited by 10
“However, patients who cannot tolerate long-term OAC therapy or those with a large thrombotic burden require local therapy such as LAA mechanical exclusion either by surgical excision or percutaneous closure device implantation [5,6].”
BackgroundSurgical options for atrial fibrillation treatment during concomitant cardiac procedures
Baudo, M., Rosati, F., Lapenna, E., Bacco, L. D., & Benussi, S. (2024) · Annals of Cardiothoracic Surgery · doi:10.21037/acs-2023-afm-0208 · Cited by 10
“A liquid refrigerant (nitrous oxide or argon) is pressurized to the inner lumen of the ablation probe; here, it is transformed from liquid to gas and it cools the tissue by energy absorption (45).”
BackgroundCongenital Absence of Left Atrial Appendage in a Patient with Intracranial Hemorrhage
Sciascio, G. D. (2015) · American Journal of Case Reports · doi:10.12659/ajcr.894331 · Cited by 10
“It is estimated that 90% of left atrial thrombi are located there [4] and percutaneous closure is therefore preferred in patients with absolute contraindication to oral anticoagulant.”
BackgroundEmbryology and Anatomy of the Left Atrial Appendage
Kanmanthareddy, A., Reddy, Y. M., Vallakati, A., Earnest, M., Nath, J., Ferrell, R., Dawn, B., & Lakkireddy, D. (2014) · Interventional Cardiology Clinics · doi:10.1016/j.iccl.2013.11.002 · Cited by 10
Kebernik, J., Jose, J., Abdel‐Wahab, M., Stöcker, B., Geist, V., & Richardt, G. (2015) · Cardiology and Therapy · doi:10.1007/s40119-015-0053-z · Cited by 10
“originate from left atrial appendage (LAA) [6], LAA closure (LAAC) devices were developed to prevent thromboembolic events and to avoid long-term OAC.”
Left Atrial Appendage Closure for Stroke Prevention
Iskandar, S., Vacek, J. L., Lavu, M., & Lakkireddy, D. (2016) · Cardiology Clinics · doi:10.1016/j.ccl.2015.12.009 · Cited by 10
Percutaneous closure of the left atrial appendage in patients with diabetes mellitus
Azizy, O., Rammos, C., Lehmann, N., Rassaf, T., & Kälsch, H. (2017) · Diabetes and Vascular Disease Research · doi:10.1177/1479164117712176 · Cited by 10
Indication, Patient Selection, and Referral Pathways for Left Atrial Appendage Closure
Dar, T. A., Turagam, M. K., Yarlagadda, B., Tantary, M., Sheldon, S. H., & Lakkireddy, D. (2018) · Interventional Cardiology Clinics · doi:10.1016/j.iccl.2017.12.003 · Cited by 10
Current State of Left Atrial Appendage Closure
Kosturakis, R., & Price, M. J. (2018) · Current Cardiology Reports · doi:10.1007/s11886-018-0981-z · Cited by 10
Coronary Artery Embolism: Two Case Reports and a Review of the Literature
Vendittelli, P., Botros, B., Rosman, H., Govindaraju, V., Zaitoun, A., & Marroush, T. S. (2018) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2018.11.003 · Cited by 10
Malone, F. E., McCarthy, E., Delassus, P., Buhk, J.-H., Fiehler, J., & Morris, L. G. (2019) · Stroke · doi:10.1161/strokeaha.118.023581 · Cited by 10
“Atrial fibrillation (AF) is the most significant contributor to cardiogenic emboli formation, causing 45% of all cardioembolic strokes.(3,4) Choi et al(5) showed that AF can increase the incidence of carotid embolism.”
BackgroundParashar, A., Tuzcu, E. M., & Kapadia, S. R. (2015) · Europe PMC (PubMed Central) · doi:10.4022/jafib.1236 · Cited by 10
Xu, L., Chen, T., Liu, G., Guo, Y., Shi, X., Chen, Y., Li, Y., & Guo, J. (2021) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-021-02490-8 · Cited by 10
Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach
Branzoli, S., Guarracini, F., Marini, M., D’Onghia, G., Penzo, D., Piffer, S., Peterlana, D., Graffigna, A., Gulizia, M. M., Gelsomino, S., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm11010176 · Cited by 10
“The left atrial appendage (LAA) is known for being the principal site of thrombi formation in patients with atrial fibrillation (AF) [1].”
BackgroundVallurupalli, S., Sharma, T., Al’Aref, S., Devabhaktuni, S. R., & Dhar, G. (2021) · Kidney360 · doi:10.34067/kid.0004082021 · Cited by 11
“Ninety percent of thrombi occur within the left atrial appendage in patients with nonvalvular atrial fibrillation (15).”
BackgroundShiraki, H., Tanaka, H., Yamauchi, Y., Yoshigai, Y., Yamashita, K., Tanaka, Y., Sumimoto, K., Shono, A., Suzuki, M., Yokota, S., et al. (2022) · The International Journal of Cardiovascular Imaging · doi:10.1007/s10554-021-02403-z · Cited by 10
“The sensitivity and specificity of TEE for diagnosing thrombus in the LAA are 93–100% and 99–100%, respectively [12], but because of the complex nature of this structure, small (< 2 mm) thrombi can be missed.”
BackgroundQiao, J., Zhang, B., Wang, J., Pan, L., Cheng, T., Wang, Y., & Xiong, E. (2022) · Cardiology · doi:10.1159/000524626 · Cited by 10
Left Atrial Appendage Morphology and Physiology: “The Missing Piece in the Puzzle”
Romero, J. E., Natale, A., & Biase, L. D. (2015) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12746 · Cited by 10
Abelson, M. J. (2013) · Cardiovascular journal of South Africa/Cardiovascular journal of Southern Africa · doi:10.5830/cvja-2013-018 · Cited by 10
“Surgical exclusion of the LAA at the time of mitral valve surgery or CABG has been shown to reduce the incidence of cardiac embolic events in patients with AF.(14) It is on this basis that percutaneous exclusion of the LAA has been developed, initially using the Plato device(15) (no longer in production) and followed…”
Stroke in atrial fibrillation—hope on the horizon?
Jamil‐Copley, S., & Kanagaratnam, P. (2010) · Journal of The Royal Society Interface · doi:10.1098/rsif.2010.0344.focus · Cited by 10
“In more than 90 per cent of patients with AF, stroke is owing to thrombotic embolization from the left atrial appendage (LAA) (Aberg 1969; Tsai et al. 1990; Manning et al. 1995; Blackshear & Odel 1996).”
BackgroundFirst experience with the Watchman FLX occluder for percutaneous left atrial appendage closure
Seeger, J., Birkemeyer, R., Rottbauer, W., & Wöhrle, J. (2017) · Cardiovascular revascularization medicine · doi:10.1016/j.carrev.2017.04.018 · Cited by 10
Akca, F., Verberkmoes, N. J., Verstraeten, S. E., van Laar, C., van Putte, B. P., & van Straten, A. H. M. (2017) · Netherlands Heart Journal · doi:10.1007/s12471-017-0987-y · Cited by 10
“Previous studies report that the LAA is the source of thrombi in up to 90% of the patients [13].”
BackgroundUssia, G. P., Mangiafico, S., Privitera, A., Mulè, M., Caruso, E., Galassi, A. R., Famoso, G., & Tamburino, C. (2006) · Journal of Cardiovascular Medicine · doi:10.2459/01.jcm.0000237902.57764.4c · Cited by 10
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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