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
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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“Residual LAA flow or incomplete LAA exclusion can increase stroke risk.465”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [465]
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Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström‐Lundqvist, C., Boriani, G., Castella, M., Dan, G.-A., Dilaveris, P., et al. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa612 · Cited by 10,550
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Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403
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
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 12
- Issue
- 7
- Pages
- 1431-1437
- ISSN
- 1547-5271 (ISSN-L)
- 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
- 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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