Interventional Closure of the Left Atrial Appendage for Stroke Prevention

Matsuo, Yasushige; Sandri, Monica; Mangner, Norman; Majunke, Nicolas; Dähnert, Ingo; Schuler, Gerhard; Kurabayashi, Masahiko; Möbius‐Winkler, Sven

doi:10.1253/circj.cj-13-0828

Cited by 21 publications

(16 citation statements)

References 32 publications

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“…In contrast, the safety event rate was much lower (2.2%) in the more recently conducted PREVAIL trial. 11 Adverse event rates were similar in the single-center 15,17,[20][21][22]24 and the multicenter studies. 18,23,25,26 We did not find robust comparative effectiveness data to directly assess the relative rates of serious safety events according to the device used.…”

Section: Circ Cardiovasc Qual Outcomesmentioning

confidence: 76%

“…Several observational studies included patients ineligible for LT-OAC therapy, 17,20,21,23,24,26 and while most found low rates of stroke over 1 to 2 years of follow-up, at least 1 study found higher incidence of stroke during a longer follow-up period. 17 Of note, even though warfarin was not used, patients in most of these studies used dual antiplatelet therapy for a duration ranging from 4 weeks to 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…However, data on longer-term safety from the observational studies are limited, in part, by high rates of attrition, 23 lack of information about the loss to follow-up, 15,[18][19][20][21] wide variation in follow-up duration (6 months to 5 years), and the lack of a consistent standard for adverse events reporting.…”

Section: Circ Cardiovasc Qual Outcomesmentioning

confidence: 99%

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Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence

Noelck

Papak

Freeman

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background-Atrial fibrillation is an important cause of cardioembolic stroke. Oral anticoagulants (OAC) reduce stroke risk but increase the risk of serious bleeding. Left atrial appendage (LAA) procedures have been developed to isolate the LAA from circulating blood flow, as an alternative to OAC. We conducted a systematic review of the benefits and harms of surgical and percutaneous LAA exclusion procedures. Methods and Results-We searched multiple data sources, including Ovid MEDLINE, Cochrane, and Embase, through January 7, 2015. Of 2567 citations, 20 primary studies met prespecified inclusion criteria. We abstracted data on patient characteristics, stroke, mortality, and adverse effects. We assessed study quality and graded the strength of evidence using published criteria. Trials found low-strength evidence that percutaneous LAA exclusion confers similar risks of stroke and mortality as continued OAC, but this evidence was limited to the Watchman device in patients eligible for long-term OAC. Observational studies found moderate-strength evidence of serious harms with a variety of percutaneous LAA procedures. There is low-strength evidence that surgical LAA exclusion does not add significant harm during heart surgery for another indication, but evidence on stroke reduction is insufficient. Conclusions-There is limited evidence that the Watchman device may be noninferior to long-term OAC in selected patients.Data on effectiveness of LAA exclusion devices is lacking in patients ineligible for long-term OAC. Percutaneous LAA devices are associated with high rates of procedure-related harms. Although surgical LAA exclusion during heart surgery does not seem to add incremental harm, there is insufficient evidence of benefit. (Circ Cardiovasc Qual Outcomes. 2016;9:395-405.

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Section: Circ Cardiovasc Qual Outcomesmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence

Noelck

Papak

Freeman

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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“…4, 5 A previous study has shown that a mobile, ball-type thrombus is an important risk factor for cerebral/arterial embolism 6 and a recent study reported that transcatheter LAA closure is safe and feasible. 7 In other study, reverse remodeling of the LAA after catheter ablation (CA) was reported, 8 so LAA morphology has received a lot of attention in recent years. Recently, some studies reported that 29-50% in AF patients have a "chicken wing (CW)" type LAA, but that this shape is less likely to influence stroke events in patients with AF.…”

Section: Patient Populationmentioning

confidence: 99%

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity?

Kishima

Mine

Ashida

et al. 2015

Circ J

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Background:The shape of the left atrial appendage (LAA) might affect thrombus formation. The chicken wing-type LAA (CW) has been reported as unlikely to influence stroke events in atrial fibrillation (AF) patients, so we investigated whether LAA shapes could influence LAA function. Methods and Results:We studied 102 patients (64 men, age 65±9 years) who underwent transthoracic echocardiography, transesophageal echocardiography (TEE), and cardiac computed tomography prior to catheter ablation (CA) for AF. LAA morphology were classified into 2 types: (1) CW: LAA with a bend in its shape and (2) non-CW type (NCW): LAA without any bends. All patients were classified into these groups using a cutoff value of LAA flow velocity (LAAFV). Patients with LAAFV <35 cm/s were classified as the low LAAFV group (Low FV, n=37). The patients with LAAFV >35 cm/s were classified as normal LAAFV group (Normal FV, n=65). The NCW type was detected in 25/102 patients (25%). In multivariate analysis, the patients with Low FV were associated with NCW type (P=0.0429, odds ratio [OR] 9.664, 95% confidence interval [CI] 1.075-86.900) and higher B-type natriuretic peptide (BNP) (P=0.0350, OR 1.012 for each 1 pg/ml increase in BNP, 95% CI 1.001-1.022). Conclusions:The NCW-type LAA and higher BNP were associated with lower LAAFV. One reason for the frequent cardiogenic stroke in patients with the NCW-type LAA may be the lower LAAFV. (Circ J 2015; 79: 1706 -1711

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“…In order to perform a complete LCCA/A, several factors need to be considered. 12, 13 First, significant variation exists among AF patients in LAA size, wall thickness and morphology (Figure 2). 14 In the "chicken wing" or "windsock" type (Figures 2A, B), a significant remnant may be left if the proximal neck of the LAA is not well identified.…”

Section: Why Should Laac/a Be Recommended At the Time Of Surgery?mentioning

confidence: 99%

Closure of the Left Atrial Appendage During Cardiac Surgery　– Why, When and How? –

Bando

Hara

2015

Circ J

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Interventional Closure of the Left Atrial Appendage for Stroke Prevention

Cited by 21 publications

References 32 publications

Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence

Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity?

Closure of the Left Atrial Appendage During Cardiac Surgery　– Why, When and How? –

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Interventional Closure of the Left Atrial Appendage for Stroke Prevention

Cited by 21 publications

References 32 publications

Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence

Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity?

Closure of the Left Atrial Appendage During Cardiac Surgery – Why, When and How? –

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Product

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Closure of the Left Atrial Appendage During Cardiac Surgery　– Why, When and How? –