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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“Based on the findings that approximately 90% of thrombi in patients with non-valvular AF originate from the left atrial appendage (LAA) (7), percutaneous left atrial appendage occlusion (LAAO) has the potential to be an alternative to OAC for stroke prevention, and the safety and efficacy of the WATCHMAN device (Bosto…”
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“[2].”
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“17,18 Around 90% of left atrial thrombi are located in the left atrium appendage, 19,20 this is even higher in CKD patients, due to its influence on the prothrombotic state.”
BackgroundCarotid stenting for symptomatic carotid artery web: Multicenter experience
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“13,14 Oral anticoagulants have proven to be superior to dual-antiplatelet therapy in preventing stroke in patients with atrial fi brillation.”
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“As an attachment structure of the left atrium, the left atrial appendage (LAA) is often more prone to blood stasis and thrombosis, which also underlies the high risk of stroke in patients with AF (11).”
Min, X. P., Zhu, T.-Y., Han, J., Li, Y., & Xu, M. (2015) · Herz · doi:10.1007/s00059-015-4350-z · Cited by 6
Velthuis, S., Swaans, M. J., Mager, J. J., Rensing, B. J. W. M., Boersma, L. V. A., & Post, M. C. (2012) · Case Reports in Cardiology · doi:10.1155/2012/646505 · Cited by 6
“Previous studies demonstrated that the LAA is the source of thrombi in more than 90% of patients with nonvalvular AF [11], which led to the development of the Watchman left atrial appendage occlusion device.”
BackgroundUnmasking a naked left atrial appendage closure device: A case of a silent embolic threat
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“Excision, ligation, or clipping of the LAA could eliminate this mechanism of AF.”
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“The implanted ACP can adopt 3 different shapes9 based on its degree of expansion: (1) ‘‘strawberry’’, (2) ‘‘tirelike’’, and (3) ‘‘square’’ shape.”
BackgroundEftekhari, A., Damgaard, D., & Grove, E. L. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.03.147 · Cited by 6
Percutaneous left atrial appendage closure devices: safety, efficacy, and clinical utility
Swaans, M. J., Wintgens, L. I. S., Alipour, A., Rensing, B. J. M. W., & Boersma, L. V. A. (2016) · Medical Devices Evidence and Research · doi:10.2147/mder.s65492 · Cited by 6
Technological Improvements in Cardiac Thrombus Diagnosis
Hur, J., Hong, Y. J., Im, D. J., Lee, H., Kim, Y. J., & Choi, B. W. (2017) · Cardiovascular Imaging Asia · doi:10.22468/cvia.2017.00031 · Cited by 6
“An estimated 47% of thrombi in valvular AF and 91% of those in nonvalvular AF are located in the LAA [22].”
BackgroundFerlini, M., & Rossini, R. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.09.015 · Cited by 6
“Left atrial appendage has been shown as the primary source of thrombi in patients with non-valvular atrial fibrillation (AF) [1].”
BackgroundPrice, M. J. (2018) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2018.01.002 · Cited by 6
Long-term left atrial thrombi after mitral valve replacement
Chen, J., Wang, H., Xie, X., Dai, H., Zhou, M., Zheng, Y., & Zhao, L. (2020) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-020-02187-4 · Cited by 6
Shirasaka, T., Kunioka, S., Narita, M., Ushioda, R., Shibagaki, K., Kikuchi, Y., Wakabayashi, N., Ishikawa, N., & Kamiya, H. (2021) · The Korean Journal of Thoracic and Cardiovascular Surgery · doi:10.5090/jcs.21.048 · Cited by 6
“Surgical occlusion of the left atrial appendage (LAA) is important for stroke prevention in patients with mitral valve disease and atrial fibrillation (AF) [1].”
BackgroundImpact of Left Atrial Appendage Amputation on Left Atrial Morphology and Rhythm after Off-Pump CABG
Gerçek, M., Ghabrial, M., Glaubitz, L., Kuß, O., Aboud, A., Paluszkiewicz, L., Gummert, J. F., Börgermann, J., & Gerçek, M. (2021) · The Thoracic and Cardiovascular Surgeon · doi:10.1055/s-0041-1735809 · Cited by 6
Exclusion versus preservation of the left atrial appendage in rheumatic mitral valve surgery
Kim, W. K., Kim, H. J., Kim, J. B., Jung, S. H., Choo, S. J., Chung, C. H., & Lee, J. W. (2020) · Heart · doi:10.1136/heartjnl-2019-316387 · Cited by 7
Kleinecke, C., Gloekler, S., & Meier, B. (2020) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2020.1794820 · Cited by 6
Alternatives to warfarin in atrial fibrillation: drugs and devices
Bayard, Y. L., Ostermayer, S. H., & Sievert, H. (2008) · Heart · doi:10.1136/hrt.2007.118844 · Cited by 6
“LEFT ATRIAL APPENDAGE TRANSCATHETER OCCLUSION A meta-analysis of several surgical, echocardiographic and autopsy studies showed that 90% of all cardiogenic thrombi in nonrheumatic atrial fibrillation originate from the left atrial appendage.(22) The risk for embolic stroke is especially high when left atrial appendage…”
BackgroundEchocardiographic Guidance of AMPLATZER Amulet Left Atrial Appendage Occlusion Device Placement
Subramaniam, K., Ibarra, A. J., & Boisen, M. L. (2018) · Seminars in Cardiothoracic and Vascular Anesthesia · doi:10.1177/1089253218758463 · Cited by 6
Secondary Prevention of Cardioembolic Stroke: Oldest and Newest Promises
Corea, F., Spinelli, M., Tambasco, N., Silvestrelli, G., & Parnetti, L. (2006) · Clinical and Experimental Hypertension · doi:10.1080/10641960600549900 · Cited by 6
Block, P. C. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.03.001 · Cited by 6
Editorial commentary: Percutaneous left atrial appendage closure for stroke prevention
Saw, J. (2015) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2015.06.006 · Cited by 6
“[4] Blackshear JL, Odell JA.”
Anticoagulation Failure in Stroke: Causes, Risk Factors, and Treatment
Choi, Y.-B., & Kim, J. S. (2025) · Journal of Stroke · doi:10.5853/jos.2025.00206 · Cited by 6
“76 While LAAO is most often used in patients who are unsuitable for long-term anticoagulation, its role has expanded.”
Karakasis, P., Tzeis, S. E., Samaras, A., Vlachos, K. G., Pamporis, K., Theofilis, P., Tzikas, A., Antoniadis, A. P., Jaı̈s, P., & Fragakis, N. (2026) · EP Europace · doi:10.1093/europace/euag159 · Cited by 5
“Third, procedural complications and device-related issues unique to LAAC, such as device embolization, pericardial effusion, and PDL, represent important treatment-related harms and should be considered in the overall safety assessment.”
Current evidence and indications for left atrial appendage closure
Shinohara, M., Saji, M., Koike, H., Ohara, H., Enomoto, Y., Nakanishi, R., Fujino, T., & Ikeda, T. (2025) · Journal of Cardiology · doi:10.1016/j.jjcc.2025.01.014 · Cited by 5
Managing the Left Atrial Appendage in Atrial Fibrillation: Current State of the Art
Khawar, W., Smith, N., & Masroor, S. (2017) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2017.05.036 · Cited by 5
“This was later confirmed by Blackshear and Odell [5] in 1996.”
Features of the Left Auricle with Various Heart Shape Among Aged Women
Ovcharenko, T. A., Krugovikhin, S. A., & Starchik, D. A. (2018) · Journal of Anatomy and Histopathology · doi:10.18499/2225-7357-2018-7-2-58-62 · Cited by 5
Champagne, C., Dognin, N., Rodés‐Cabau, J., & Champagne, J. (2021) · European Heart Journal - Case Reports · doi:10.1093/ehjcr/ytab187 · Cited by 5
“Generally, the most common complication of this procedure is a pericardial effusion.4 Most effusions occur at the time of the LAA closure device deployment or during manipulations of the sheaths deep inside the LAA.”
BackgroundInfluentialLi, C., Dou, G., Ding, Y., Xin, R., Wang, J., Guo, J., Chen, Y., & Yang, J. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12030437 · Cited by 5
“As shown in previous reports, the left atrial appendage (LAA) may harbor up to 90% of thrombi occurring in patients with AF [2].”
ResultSong, Y., Xing, H., Koch, P. D., Li, X., & Zhang, Y. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.1080257 · Cited by 5
“The rationale behind its use is that 90% of the thrombi originate from left atrial appendage (4).”
BackgroundGolzarian, H., Mariam, A., Shah, S. R., Pasley, B. A., Ansah, K. N., Verma, A., Mehzad, R., & Patel, S. M. (2023) · European Heart Journal - Case Reports · doi:10.1093/ehjcr/ytad160 · Cited by 5
“For decades, clinicians have attempted various surgical and non-surgical approaches for LAA occlusion (LAAO).(3) These approaches include but are not limited to suture exclusion or excision, suture/snares loops, and clipping.”
BackgroundAppropriate use criteria of left atrial appendage closure devices: latest evidences
Guarracini, F., Bonvicini, E., Preda, A., Martín, M. J., Muraglia, S., Casagranda, G., Mochen, M., Coser, A., Quintarelli, S., Branzoli, S., et al. (2023) · Expert Review of Medical Devices · doi:10.1080/17434440.2023.2208748 · Cited by 5
Percutaneous Left Atrial Appendage Occlusion Therapy: Evolution and Growing Evidence
Han, X.-Q., & Benditt, D. (2023) · Reviews in cardiovascular medicine · doi:10.31083/j.rcm2407211 · Cited by 5
“…particularly stroke, are among the most important adverse events associated with atrial fibrillation (AF) [1–3], and the left atrial appendage (LAA), with its muscular trabeculations and often complex multilobular structure has long been considered the principal site of atrial clot formation [4,5].”
BackgroundHozman, M., Heřman, D., Zemánek, D., Fišer, O., Vrba, D., Poloczek, M., Varvařovský, I., Obona, P., Pokorný, T., & Osmancik, P. P. (2023) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.30867 · Cited by 5
“22,23 5 | STUDY LIMITATIONS Our study has several limitations.”
BackgroundWei, C. R., Lim, R., Khan, S. A., Ahsan, S. A., Omari, M. A., Sherpa, N. D., Rashid, Z., & Khan, A. (2023) · Cureus · doi:10.7759/cureus.49827 · Cited by 5
Left atrial appendage occlusion in atrial fibrillation for stroke prevention: A systemic review
Zhou, X., Zhang, W., Lv, W., Zhou, Q., Li, Y., Zhang, L., Lu, Y., Zhang, J., Xing, Q., Wang, H., et al. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.10.011 · Cited by 5
Sedaghat, A., Nickenig, G., & Hammerstingl, C. (2014) · Clinical Research in Cardiology · doi:10.1007/s00392-014-0704-4 · Cited by 5
“Evidence is grown, that more than 90 % of cardiac thrombi are found within the LAA [5], indicating a relevant number of cardiac emboli arising from the LAA.”
BackgroundSohaib, S. M. A., & Fox, K. F. (2015) · PubMed Central · doi:10.3978/j.issn.2072-1439.2015.08.03 · Cited by 5
“In 90% of patients with non-valvular AF and intracardiac thrombus, the left atrial appendage (LAA) is thought to be the location (1).”
BackgroundHybrid dual stage closed chest ablation of persistent atrial fibrillation
Wojtaszczyk, A., Buchta, P., Myrda, K., Gąsior, M., Kowalski, O., Kalarus, Z. F., Filipiak, K. J., Zembala, M., & Zembala, M. (2017) · Cor et Vasa · doi:10.1016/j.crvasa.2017.06.008 · Cited by 5
Chow, D. H. F., Bieliauskas, G., Sawaya, F., Millán-Iturbe, Ó., Kofoed, K. F., Backer, O. D., & Søndergaard, L. (2017) · Structural Heart · doi:10.1080/24748706.2017.1405174 · Cited by 5
“The left atrial appendage (LAA) accounts as a source of thromboembolism in 90% of patients with NVAF.(2) The latest European Society of Cardiology (ESC) guidelines for management of AF (2016) suggest a class IIb recommendation for percutaneous LAA closure as an option in patients with high stroke risk and contraindica…”
BackgroundPercutaneous left atrial appendage closure using the TrueFusion™ fusion-imaging technology
Nelles, D., SCHRICKEL, J. W., Nickenig, G., & Sedaghat, A. (2019) · Clinical Research in Cardiology · doi:10.1007/s00392-019-01566-z · Cited by 5
Barocelli, F., Coli, S., Crocamo, A., Guidorossi, A., Cattabiani, M. A., Preti, F., Bosi, D., Spaziani, C., Lina, D., Menozzi, A., et al. (2020) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000000976 · Cited by 5
Tapias, J. B., Flores‐Umanzor, E., Guillén, P. L. C., Regueiro, A., Sanchís, L., Broseta, J. J., Cases, A., & Freixa, X. (2021) · Nefrología · doi:10.1016/j.nefro.2021.02.008 · Cited by 5
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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