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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Obliteration of the left atrial appendage: A concept worth testing
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“The left atrial appendage (LAA) has long been recognized as the main reservoir for thrombi in the setting of nonvalvular AF (6).”
BackgroundThe WATCHMAN Device Review: A new era for stroke prophylaxis
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A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion
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“According to studies, over 90% of cardiac thrombi forms in LAA in non-valvular AF [6].”
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“In addition, although there was a predilection for thrombi formation in the left atrial appendage for patients with NVAF, such might not be the case for those with rheumatic mitral stenosis [11].”
BackgroundMorphology of the Left Atrial Appendage: Prevalence and Gender Difference in a Kenyan Population
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“Specifically, the LAA is the site of thrombus formation in approximately 91% of patients with nonvalvular AF and 57% of patients with valvular AF.4 Although exclusion of the LAA is frequently performed as an adjunct to other cardiac procedures, the mainstay of thromboembolism prophylaxis in AF has traditionally been s…”
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“This assertion is substantiated by numerous previous studies consistently demonstrating a robust link between thrombus formation within the LAA and AF [2, 3].”
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“In patients with AF, the source of cardioembolic stroke in >90% of the cases is thrombi in the left atrial appendage (LAA) as detected by transesophageal echocardiography (TEE) or autopsy studies [4,5].”
BackgroundUnderstanding the role of the left atrial appendage on the flow in the atrium
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“Blackshear reported that in patients with AF, left atrial thrombi was most commonly found in the LAA in 91% of nonvalvular AF and 57% of valvular AF [65].”
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“Transoesophageal echocardiography studies suggest the left atrial appendage is the source of the thrombus in over 90% of patients with AF who suffer a stroke [22].”
BackgroundPercutaneous left atrial appendage closure
Nietlispach, F., Gloekler, S., Khattab, A. A., Pilgrim, T., Schmid, M., Wenaweser, P., Windecker, S., & Meier, B. (2012) · European Geriatric Medicine · doi:10.1016/j.eurger.2012.03.012 · Cited by 9
“Not surprisingly, 91% of thrombi in patients with non-rheumatic atrial fibrillation are therefore found in the LAA [22] (Fig.”
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“Since LAA is the source of thrombus in 90% of patients with nonvalvular AF [10], patients with AF who require CABG are appropriate candidates for pulmonary vein ablation and epicardial LAA occlusion.”
BackgroundThe feasibility of substituting left atrial wall strain for flow velocity of left atrial appendage
Miyoshi, A., Nakamura, Y., Kazatani, Y., & Ito, H. (2017) · Acta cardiologica. Supplementum · doi:10.1080/00015385.2017.1351242 · Cited by 9
“limited cavity of the LAA [15,16]; therefore, this consti-”
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“Many studies have demonstrated that the left atrial appendage (LAA) is the site of thrombus formation in approximately 90% of patients with central sources of thromboembolism and nonvalvular atrial fibrillation.(1) Herein, we describe a case of acute dislodgment and embolization of an LAA.”
BackgroundFirst results of the Brazilian Registry of Percutaneous Left Atrial Appendage Closure
Guérios, Ê. E., Chamié, F., Montenegro, M. J., Saad, E., de Brito, F. S., Caramori, P., Simões, L. C., de Oliveira, F. R. A., Giuliano, L. C., & Tavares, C. M. D. F. (2017) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20170150 · Cited by 9
Patient selection and methods of surgical left atrial appendage exclusion
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Current practice and future prospects in left atrial appendage occlusion
Narasimhan, B., Aedma, S. K., Bhatia, K., Garg, J., Kanuri, S. H., Turagam, M. K., & Lakkireddy, D. (2021) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14284 · Cited by 9
“Blackshear and Odell’s work establishing the LAA as the primary source of thromboembolism in non-valvular AF (91%) led to a resurgence of interest in the LAAO(13).”
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“The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation (1-3).”
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Age-related changes in morphology of left atrial appendage in patients with atrial fibrillation
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Fatal complications associated with surgical left atrial appendage exclusion
Wehbe, M. S., Doll, N., & Merk, D. R. (2018) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2018.05.066 · Cited by 9
“DISCUSSION The LAA, infamously labeled ‘‘our most lethal attachment’’(2) because of its inherent anatomy and the pathophysiologic mechanisms associated with AF (hypercoagulability, endothelial damage), is the main source of cardiogenic emboli, accounting for 57% and 91% of thrombi in valvular and nonvalvular AF, respe…”
BackgroundAtrial Fibrillation in Heart Failure
Ellis, C. R., & Kanagasundram, A. N. (2019) · Cardiology Clinics · doi:10.1016/j.ccl.2019.01.009 · Cited by 9
A 79-Year-Old Woman with Atrial Fibrillation and New Onset of Heart Failure
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Preoperative Planning for Structural Heart Disease
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The significance of atrial fibrillation ablation in patients undergoing mitral valve surgery
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“Elimination of the left atrial appendage may be performed as an additional procedure during cardiac valve surgery (6, 31), as part of the “Maze procedure” (7), as an isolated procedure by thoracoscopy ( 5 , 18, 23) or as a percutaneous intervention by means of the PLAATO TM (percutaneous left atrial appendage transcat…”
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“2%, which is consistent with other literature [6].”
BackgroundResult3D-Printed models for left atrial appendage occlusion planning: a detailed workflow
Stomaci, T., Buonamici, F., Gelati, G., Meucci, F., & Carfagni, M. (2023) · Rapid Prototyping Journal · doi:10.1108/rpj-10-2022-0351 · Cited by 8
Is It Safe to Preserve Left Atrial Appendage During Maze Procedure?
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LAA occluder device for stroke prevention: Data on WATCHMAN and other LAA occluders
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Totally Thoracoscopic Closure of the Left Atrial Appendage
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“viously shown more than 90% of atrial thrombi in nonvalvular AF occur within the left atrial appendage (LAA).(1) The primary preventive Abbreviations: 2D, two-dimensional; 3DRA, three-dimensional rotational angiography; AF, atrial fibrillation; CAUD, caudal; CT, computed tomography; LAA, left atrial appendage; LAP, le…”
BackgroundLifetech LAmbre: A New Promising and Novel Device in the Interventional Stroke Prevention
Schnupp, S., Ajmi, I., Brachmann, J., & Mahnkopf, C. (2019) · Future Cardiology · doi:10.2217/fca-2019-0040 · Cited by 8
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“The mechanism of ischemic stroke in nonvalvular AF (NVAF) mainly results from embolization from left atrial appendage (LAA) thrombi (Blackshear and Odell, 1996).”
BackgroundPommier, T., Leclercq, T., Guénancia, C., Richard, C., Porot, G., Laurent, G., & Lorgis, L. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10153443 · Cited by 8
“There are several methods of LAA closure, including percutaneous [8] and surgical approaches [9].”
MethodHe, B., Ma, C., & Wu, S. (2022) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14448 · Cited by 8
“2020;75(25):3122-3135; PINNACLE FLX, Circulation.”
Ouchi, K., Sakuma, T., Higuchi, T., Yoshida, J., Narui, R., Nojiri, A., Yamane, T., & Ojiri, H. (2022) · Heart and Vessels · doi:10.1007/s00380-022-02041-y · Cited by 8
“Atrial fibrillation (AF) is the most common cause of cardiogenic embolism: more than 90% of embolic strokes are caused by the formation of thrombi in the left atrial appendage (LAA) [1, 2].”
BackgroundAtrial fibrillation in older adults with cancer.
Kumar, M., Lopetegui‐Lia, N., Malouf, C. A., Almnajam, M., Coll, P. P., & Kim, A. S. (2022) · PubMed Central · doi:10.11909/j.issn.1671-5411.2022.01.001 · Cited by 8
“For example, fall risk or a history of falls may be cited as a reason for not starting anticoagulation or stopping an anticoagulant when the risk benefit for most of these patients favours anticoagulation.([38]) In the vast majority of cases, the left atrial appendage (LAA) is thought to be the origin of embolic strok…”
BackgroundSafety of left atrial appendage closure in heart failure patients
Das, S., Ros, M. L., Wu, L., Mehta, D., & Suri, R. (2022) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15682 · Cited by 8
“This emergent therapeutic option was based on the echocardiographic data that 91% of thrombus that led to embolic stroke in patients with nonvalvular AF originated in the LAA.7 Only the WATCHMAN (PMA: P130013) and the Amplatzer Amulet (PMA: P200049) devices are currently Food and Drug Administration (FDA) approved.8,9…”
BackgroundAl-Terki, H., Mügge, A., & Gotzmann, M. (2022) · European Heart Journal - Case Reports · doi:10.1093/ehjcr/ytac434 · Cited by 8
Gerçek, M., Börgermann, J., Gummert, J. F., & Gerçek, M. (2023) · Clinical Research in Cardiology · doi:10.1007/s00392-023-02255-8 · Cited by 8
“Since the left atrial appendage (LAA) is known to be the major origin of stroke caused by thrombi [10], the exclusion of the left atrial appendage by intervention or surgery (concomitant with cardiac surgery) has become a field of rising interest [10].”
BackgroundA Comparative Study of Thoracoscopic Left Atrial Appendage Clipping vs Stapled Resection
Lim, S. K., Kim, C. H., Choi, K. H., Ahn, J., On, Y. K., Kim, S. M., & Jeong, D. S. (2023) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2023.09.010 · Cited by 8
Garg, P., & Walton, A. (2008) · Heart Lung and Circulation · doi:10.1016/j.hlc.2007.10.019 · Cited by 8
Cost of Atrial Fibrillation: Invasive vs Non-Invasive Management in 2012
Khaykin, Y., & Shamiss, Y. (2012) · Current Cardiology Reviews · doi:10.2174/157340312803760730 · Cited by 8
Bode, W. D., Patel, N. A., & Gehi, A. K. (2015) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-015-9988-1 · Cited by 8
Murdoch, D. J., McAulay, L., & Walters, D. (2014) · Cardiovascular revascularization medicine · doi:10.1016/j.carrev.2014.04.007 · Cited by 8
“50% of patients with rheumatic atrial fibrillation [3].”
BackgroundNon-Pharmacological Therapy for Atrial Fibrillation: Managing the Left Atrial Appendage
Luis, S. A., Roper, D., Incani, A., Poon, K., Haqqani, H. M., & Walters, D. (2012) · Cardiology Research and Practice · doi:10.1155/2012/304626 · Cited by 8
“It has been shown that more than 90% of thrombi in patients with nonrheumatic, nonvalvular AF are located within this cavity [12].”
Kurakula, N., Rajasekhar, D., Vanajakshamma, V., Akula, V. S., Kasala, L., & Venkateswarlu, K. M. (2015) · Echocardiography · doi:10.1111/echo.13026 · Cited by 8
“It is now recognized that it is a structure with important pathological associations.(1) Thrombus has a predilection to form within the LAA in patients with nonvalvular atrial fibrillation and to a lesser extent in those with mitral valve disease (both in atrial fibrillation and in sinus rhythm).”
BackgroundChen, R., Wu, X., Jin, H.-H., Wang, B., Ma, M., & Zhao, B. (2015) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2015.08.011 · Cited by 8
Left Atrial Appendage Exclusion for Atrial Fibrillation
Syed, F. F., DeSimone, C. V., Friedman, P. A., & Asirvatham, S. J. (2016) · Heart Failure Clinics · doi:10.1016/j.hfc.2015.08.022 · Cited by 8
Musat, D. L. (2018) · Journal of Atrial Fibrillation · doi:10.4022/jafib.1806 · Cited by 8
“In patients with non-valvular atrial fibrillation (AF) it is well accepted, based on surgical and transesophageal echocardiography (TEE) studies, that thrombus formed within the LAA is responsible for the vast (about 90%) majority of strokes[1].”
BackgroundLeft Atrial Occlusion Device Implantation: the Role of the Echocardiographer
Altszuler, D., Vainrib, A., Bamira, D. G., Benenstein, R., Aizer, A., Chinitz, L. A., & Sarić, M. (2019) · Current Cardiology Reports · doi:10.1007/s11886-019-1151-7 · Cited by 8
Ligation of Left Atrial Appendage during Off-Pump Coronary Surgery
Тайсумович, Э. С., Kozmin, D. Y., Magomedov, G. M., Макеев, С. А., Ионович, Ч. И., Николаевич, И. Н., Тарасов, Д. Л., Zhigalov, K., & Weymann, A. (2019) · The Thoracic and Cardiovascular Surgeon · doi:10.1055/s-0039-1695758 · Cited by 8
Evaluation of left atrial remodelling following percutaneous left atrial appendage closure.
Jalal, Z., Iriart, X., Dinet, M., Corneloup, O., Pillois, X., Cochet, H., & Thambo, J. (2017) · Europe PMC (PubMed Central) · doi:10.11909/j.issn.1671-5411.2017.08.002 · Cited by 8
Left Atrial Appendage Exclusion Using the AtriClip Device: A Case Series
Page, S., Hallam, J., Pradhan, N., Cowie, B., Phan, T. D., McGlade, D. P., Rosalion, A., Newcomb, A. E., & Yii, M. Y. (2017) · Heart Lung and Circulation · doi:10.1016/j.hlc.2017.12.006 · Cited by 8
Mazzone, P., D’Angelo, G., Regazzoli, D., Molon, G., Senatore, G., Saccà, S., Canali, G., Amellone, C., Turri, R., & Bella, P. E. D. (2018) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-018-0351-1 · Cited by 8
“The finding that 91% of thrombi in this setting originate in the left atrial appendage (LAA) [3] constitutes the rationale for the development of systems for stroke prevention by means of mechanical LAA closure, such as the catheter-delivered WATCHMAN device (Boston Scientific, Marlborough, MA, USA).”
BackgroundPark, J. W., Gerk, U., Franke, R., & Jung, F. (2008) · Cardiology · doi:10.1159/000149574 · Cited by 8
Surgical Ablation of Atrial Fibrillation: The Columbia Presbyterian Experience
Topkara, V. K., Williams, M. R., Cheema, F. H., Vigilance, D. W., Garrido, M. J., Russo, M. J., Öz, M. C., & Argenziano, M. (2006) · Journal of Cardiac Surgery · doi:10.1111/j.1540-8191.2006.00273.x · Cited by 9
A 60-Year-Old Woman With Atrial Fibrillation
Singer, D. E. (2003) · JAMA · doi:10.1001/jama.290.16.2182 · Cited by 8
Interventional treatment of structural heart disease
Franke, J., Steinberg, D. H., & Sievert, H. (2009) · Minimally Invasive Therapy & Allied Technologies · doi:10.1080/13645700902920486 · Cited by 8
Preda, A., Baroni, M., Varrenti, M., Vargiu, S., Carbonaro, M., Giordano, F., Gigli, L., & Mazzone, P. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12113859 · Cited by 8
“In non-valvular AF patients, up to 98% of thrombi are located in the left atrial appendage (LAA) [4], and this finding is rather common (17%) during transesophageal echocardiography, cardiac surgery, and autopsy [5].”
BackgroundLaterra, G., Artale, C., Sacchetta, G., & Contarini, M. (2023) · European Heart Journal - Case Reports · doi:10.1093/ehjcr/ytad261 · Cited by 7
“For this reason, in 1996 LAA obliteration was first suggested as stroke prophylaxis in non-rheumatic AF.(4) In 2001, the first left atrial appendage closure (LAAC) procedure was performed, implanting an occlusion system into the LAA.”
MethodNon-Pharmacological Stroke Prevention in Atrial Fibrillation
Anduaga, I., Affronti, A., Guillén, P. L. C., Alcocer, J., Flores‐Umanzor, E., Regueiro, A., Brugaletta, S., Quintana, E., Sanchís, L., Sabaté, M., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12175524 · Cited by 8
“Numerous studies in the following years confirmed these significant observations [17,18].”
BackgroundMorphology and location of thrombus and sludge in patients with non-valvular atrial fibrillation
Cui, J. R., Xia, S., Tang, R., He, L., Guo, X., Li, S., Liu, N., Sang, C., Long, D., Du, X., et al. (2024) · BMC Cardiovascular Disorders · doi:10.1186/s12872-024-04073-w · Cited by 7
“However, the data was based on observational studies from the 1990s [5].”
BackgroundMethodLeft Atrial Spontaneous Echo Contrast: Pathogenesis, Detection, and Modelling
Melidoro, P., Lip, G. Y. H., Montarello, N., Rajani, R., Kliś, M., Williams, S. E., Aslanidi, O. V., & de Vecchi, A. (2025) · Thrombosis and Haemostasis · doi:10.1055/a-2688-6741 · Cited by 7
Sp, G., Панченко, Е. П., Mironov, N. Y., Михайловна, Б. М., Gagloeva, D. A., Elfimova, E. M., Станиславовна, К. Е., Laiovich, L. I., Litvin, A. Y., Maykov, E. B., et al. (2025) · Eurasian heart journal · doi:10.38109/2225-1685-2025-3-6-77 · Cited by 8
Inflammation and Atrial Fibrillation
Endoh, Y., Endoh, I., Geczy, C. L., Nakagomi, A., Kusama, Y., & Atarashi, H. (2011) · Journal of Arrhythmia · doi:10.1016/s1880-4276(11)80017-7 · Cited by 7
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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