Left Atrial Appendage Resection Versus Preservation During the Surgical Ablation of Atrial Fibrillation

Lee, Chee-Hoon; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

doi:10.1016/j.athoracsur.2013.07.073

Cited by 42 publications

(38 citation statements)

References 16 publications

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“…These 7 studies recruited a total of 3653 patients with an LAA occlusion group (LAAO) (1716 patients) compared to a non LAAO group (1937 patients). In three works, 37 , 39 , 42 the main operation was mitral valve surgery, in one 39 it was coronary surgery and in the other three 40 , 41 , 43 there was a mix of aortocoronary bypass and valve procedures. Four studies used surgical sutures for the LAAO 37 , 38 , 41 , 42 while in two the LAA was amputated with a Stapler 38 , 43 …”

Section: Surgical Closure (Occlusion) Of the Left Atrial Appendagementioning

confidence: 99%

“…Four studies used surgical sutures for the LAAO 37 , 38 , 41 , 42 while in two the LAA was amputated with a Stapler 38 , 43 Table 3Studies in the literature which assessed surgical treatment of the left atrial appendageAuthorPeriodType of studyNumber of LAANumber of non-LAALAA occlusion methodLee et al 39 1999–2011Propensity-score matched119119LAA amputation during crio-MazeWhitlock et al 43 2009–2010Miscellaneous2625Amputation and staplerKim et al 40 2001–2010Propensity-score matched631631Amputation or closure of LAAZapolanski et al 41 2005–2012Observational808969Double ligature with sutureNagpal et al 37 2007RCT2221Amputation, sutureHealey et al 38 2001–2002RCT5225Suture or staplerGarcia-Fernandez et al 42 1996–2001Observational58147Ligature of LAA with endocardial sutureLAA, left atrial appendage; RCT, randomized controlled trial.…”

Section: Surgical Closure (Occlusion) Of the Left Atrial Appendagementioning

confidence: 99%

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ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training

Casu¹,

Gulizia

Molon

et al. 2017

European Heart Journal Supplements

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Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at five-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban, and edoxaban). Despite these advances, many patients still do not receive adequate anticoagulation therapy because of contraindications (relative and absolute) to this treatment. Over the last decade, percutaneous closure of left atrial appendage, main site of thrombus formation during AF, proved effective in reducing thromboembolic complications, thus offering a valid medical treatment especially in patients at increased bleeding risk. The aim of this consensus document is to review the main aspects of left atrial appendage occlusion (selection and multidisciplinary assessment of patients, currently available methods and devices, requirements for centres and operators, associated therapies and follow-up modalities) having as a ground the significant evolution of techniques and the available relevant clinical data.

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Section: Surgical Closure (Occlusion) Of the Left Atrial Appendagementioning

confidence: 99%

Section: Surgical Closure (Occlusion) Of the Left Atrial Appendagementioning

confidence: 99%

ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training

Casu¹,

Gulizia

Molon

et al. 2017

European Heart Journal Supplements

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show abstract

“…Both the observational studies demonstrated no significant difference in stroke-free survival during the course of their follow-up, but important data such as information about anticoagulation use among the groups was lacking. 32,33 One study evaluated success of surgical LAA closure as determined by postoperative TEE after a mean time of 8.1±12 months. 31 Of 137 patients who underwent surgical excision, only 40% of all closures were successful.…”

Section: Circ Cardiovasc Qual Outcomesmentioning

confidence: 99%

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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“…56, 57 Patients with AF undergoing LARIAT percutaneous LAA ligation (detailed below) have a marked reduction in circulating renin, aldosterone, and noradrenaline levels (unpublished). 58 …”

Section: Left Atrial Appendage Structure and Functionmentioning

confidence: 99%

Left Atrial Appendage Exclusion for Atrial Fibrillation

et al. 2014

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SYNOPSIS Percutaneous left atrial appendage (LAA) closure is increasingly being used as a treatment strategy to prevent stroke in patients with atrial fibrillation (AF) who have contraindications to anticoagulants. A number of approaches and devices have been developed in the last few years, each with their own unique set of advantages and disadvantages. We review the published studies on surgical and percutaneous approaches to LAA closure; focusing on stroke mechanisms in AF, LAA structure and function relevant to stroke prevention, practical differences in procedural approach, and clinical considerations surrounding management.

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Left Atrial Appendage Resection Versus Preservation During the Surgical Ablation of Atrial Fibrillation

Cited by 42 publications

References 16 publications

ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training

ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training

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

Left Atrial Appendage Exclusion for Atrial Fibrillation

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