The ATLAS Trial: A Look Before We LeAAPS

Whitlock, Richard; Belley‐Côté, Emilie P.

doi:10.1177/15569845221130800

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…Hopefully, a definitive answer on the role of preventive LAAC in patients undergoing cardiac surgery for another indication will be provided by the Left Atrial Appendage Exclusion for Prophylactic Stroke Reduction (LeAAPS) (NCT05478304) [ 82 ] that will evaluate thromboembolic events in 6500 patients with increased risk for stroke and AF, randomly assigned to LAAC with AtriClip or not. Evaluation at follow-up of results of surgical closure, however, will not be included in the primary outcomes [ 83 ].…”

Section: Discussionmentioning

confidence: 99%

Different Techniques of Surgical Left Atrial Appendage Closure and Their Efficacy: A Systematic Review

D'Abramo¹,

Romiti²,

Saltarocchi³

et al. 2023

Rev. Cardiovasc. Med.

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Background: Atrial fibrillation has been identified as an independent risk factor for thromboembolic events. Since 1948 different surgical techniques have described the feasibility and the rationale of left atrial surgical appendage closure. The aim of this systematic review is to evaluate the reported patency rates of different surgical techniques. Methods: This systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two independent investigators searched the PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and OVID® (Wolters Kluwer, Alphen aan den Rijn, Netherlands) to identify relevant studies. Consecutively, a PICO (Population, Intervention, Comparison and Outcomes) strategy assessment of literature was performed to search eventual other relevant studies that may have been ignored. Results: A total of 42 studies were included in our analysis. The total number of patients who underwent surgical left atrial appendage closure was 5671, and in 61.2% an imaging follow up was performed, mostly with transesophageal echocardiographic evaluation. Success rate for the different techniques was: Clip deployment 98%; Lariat procedure 88%; Surgical amputation 91%; Endocardial suture 74.3%, Epicardial suture 65%; Left atrial appendage closure (LAAC) ligation 60.9%; Stapler technique with excision of left atrial appendage (LAA) 100%; Stapler without excision 70%. Conclusions: To date, data on surgical left atrial appendage closure are poor and not standardized, even if reported rates are acceptable and comparable to transcatheter procedures. If validated on large-scale non-retrospective and multicentric studies, these promising developments may offer a valuable alternative for patients with atrial fibrillation (AF) and ineligible for oral anticoagulation therapy.

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Section: Discussionmentioning

confidence: 99%

Different Techniques of Surgical Left Atrial Appendage Closure and Their Efficacy: A Systematic Review

D'Abramo¹,

Romiti²,

Saltarocchi³

et al. 2023

Rev. Cardiovasc. Med.

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“…Based on the presented data, another multicenter prospective study called LeAAPS was commenced. It aims to ultimately answer the question of concomitant surgical LAAO in patients with no AF [15].…”

Section: Left Atrial Appendage As a Legitimate Target For Thromboembo...mentioning

confidence: 99%

Left atrial appendage occlusion: Percutaneous and surgical approaches in everyday practice

Gofus,

Zacek,

Shahin

et al. 2024

Pol Heart J

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Prophylactic left atrial appendage occlusion has been suggested as a means of reducing cardioembolism risk in patients with atrial fibrillation. Its clinical benefits have been discussed together with potential endocrine or hemodynamic adverse effects, with conflicting conclusions. We aimed to provide a thorough overview of the current literature and a recommendation for daily clinical decision-making. A comprehensive Medline search through PubMed was conducted to search for relevant articles, which were further filtered using the title and abstract. Sixty-five articles were selected as relevant to the topic. Concomitant left atrial appendage occlusion during cardiac surgery for other reasons is effective in terms of thromboembolism risk reduction in patients with a history of atrial fibrillation and higher CHA 2 DS 2 -VASc scores. Surgical occlusion is safe, and epicardial closure techniques are preferred. Thoracoscopic and transcatheter techniques are also feasible, and the individual treatment choice must be tailored to the patient. The concerns about endocrine imbalance or risk of heart failure after occlusion are not supported by evidence. Current evidence is conflicting with regard to hemodynamic consequences of appendage occlusion.

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“…Although studies have explored the benefits of LAAC in patients with AF, there remains a paucity of evidence regarding its efficacy in patients without underlying AF. 14 , 15 , 16 This gap in knowledge is critical because many patients undergoing cardiac surgery may not have documented AF preoperatively, yet at the same time, may have elevated CHA 2 -DS 2 -VASc score and thromboembolic risk. It has been also speculated that LAAC may serve as bailout for patients developing postoperative AF (POAF) after cardiac surgery to reduce embolic risk and POAF-related stroke burden.…”

mentioning

confidence: 99%

Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke

Kowalewski,

Święczkowski,

Kuźma

et al. 2024

JTCVS Open

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The ATLAS Trial: A Look Before We LeAAPS

Cited by 5 publications

References 6 publications

Different Techniques of Surgical Left Atrial Appendage Closure and Their Efficacy: A Systematic Review

Different Techniques of Surgical Left Atrial Appendage Closure and Their Efficacy: A Systematic Review

Left atrial appendage occlusion: Percutaneous and surgical approaches in everyday practice

Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke

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