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Cited by 184Atrial Fibrillation Management and OutcomesCardiovascular and Diving-Related ComplicationsCardiac Arrhythmias and Treatments

The DOI matches its Crossref record; 27 of the 27 references it cites were found in a registry or an index.

Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization

Aryana, Arash, Singh, Steve K., Singh, Sheldon M., Gearoid O’Neill, P., Bowers, Mark R., Allen, Shelley L., Lewandowski, Sammi L., Vierra, Eleanor C., d’Avila, André·2015·Heart Rhythm
DOI 10.1016/j.hrthm.2015.03.028
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Abstract

Background Surgical exclusion of the left atrial appendage (LAA) can frequently yield incomplete closure.Objective We evaluated the ischemic stroke/systemic embolization (SSE) risk in patients with atrial fibrillation (AF) and complete LAA closure (cLAA) vs incompletely surgically ligated LAA (ISLL) and LAA stump after surgical suture ligation.Methods Seventy-two patients (CHA2DS2-VASc score 4.1 ± 1.9) underwent surgical LAA ligation in conjunction with mitral valve/AF surgery and postoperative LAA evaluation using computerized tomographic angiography.Results Overall, cLAA was detected in 46 of 72 patients (64%), ISLL in 17 patients (24%), and LAA stump in 9 patients (12%). The incidences of oral anticoagulation (OAC) and recurrent AF were similar among the 3 groups during 44 ± 19 months of follow-up. SSE occurred in 2% of patients with cLAA vs 24% with ISLL and 0% with LAA stump (P = .006). None of the patients with SSE were receiving OAC, and all had recurrent AF during follow-up. Additionally, patients with SSE exhibited a significantly smaller ISLL neck diameter (2.8 ± 1.0 vs 7.1 ± 2.1 mm; P = .002). The annualized SSE risk was 1.9% (entire cohort), 6.5% (ISLL patients), 14.4% (ISLL patients not receiving OAC), and 19.0% (ISLL neck diameter ≤5.0 mm) per 100 patient-years of follow-up. The latter risk was nearly 5 times greater than predicted by conventional risk-stratification schemes. Moreover, ISLL emerged as an independent predictor of SSE in univariate analyses and as the sole predictor of SSE in a multivariate analysis.Conclusion In patients with AF, ISLL is a predictor of SSE, independent of conventional risk stratification schemes. Consequently, OAC should be strongly considered in this high-risk cohort.

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  1. Labovitz, 1994, Transesophageal echocardiography in patients with unexplained cerebral ischemia: multicenter findings, Circulation, 90, 1

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Metadata

Authors
Aryana, A., Singh, S. K., Singh, S. M., Gearoid O’Neill, P., Bowers, M. R., Allen, S. L., Lewandowski, S. L., Vierra, E. C., & d’Avila, A.
Affiliations
  • Dignity Health (US)
  • Sunnybrook Health Science Centre (CA)
Corresponding author
Aryana, Arash
ORCID
Venue
Heart Rhythm
Publisher
Elsevier BV
Published
2015-07
Volume
12
Issue
7
Pages
1431-1437
ISSN
1547-5271 (ISSN-L)
DOI
10.1016/j.hrthm.2015.03.028
OpenAlex
W1602111967
Cited by
184
References
27
Citations by year
2026: 22 · 2025: 16 · 2024: 7 · 2023: 17 · 2022: 15 · 2021: 21 · 2020: 23 · 2019: 18 · 2018: 16 · 2017: 21 · 2016: 7 · 2015: 1
FWCI
10.88
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Heart Rhythm (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords
left atrial appendage, atrial fibrillation, ischemic stroke, systemic embolization, oral anticoagulation, atrial fibrillation recurrence, risk stratification, mitral valve surgery
MeSH terms
Aged, Aged, 80 and over, Atrial Fibrillation, Brazil, Female, Follow-Up Studies, Cardiac Surgical Procedures, Humans, Ligation, Male, Middle Aged, Postoperative Complications, Risk Factors, Thromboembolism, Echocardiography, Transesophageal, Risk Assessment, Atrial Appendage, Stroke, Wound Closure Techniques

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