The impact of surgical left atrial appendage amputation/ligation on stroke prevention in patients undergoing off-pump coronary artery bypass grafting

Endo, Daisuke; Kato, Tomoko S.; Iwamura, Tai; Oishi, Atsumi; Yokoyama, Yasutaka; Kuwaki, Kenji; Inaba, Hisashi; Amano, Atsushi

doi:10.1007/s00380-016-0915-x

Cited by 11 publications

(11 citation statements)

References 46 publications

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“…This study showed that exclusion of LAA by closing it using a double‐layer suture during MVR reduced the incidence of ischemic stroke during hospitalization, particulary in patients with AF. It is consistent with several other observational studies 8‐15 where LAA exclusion has been recognized as a protective factor for different types of patients undergoing cardiac surgery (Table 5).…”

Section: Discussionsupporting

confidence: 92%

Left atrial appendage exclusion is effective in reducing postoperative stroke after mitral valve replacement

et al. 2020

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Objective: This study aimed to evaluate the role of surgical left atrial appendage (LAA) exclusion in the prevention of stroke after mitral valve replacement (MVR). Methods: We retrospectively reviewed clinical data of 860 patients who received MVR in our center from January 2008 to January 2013. The patients were randomly assigned to two surgical groups, namely LAA exclusion group (n = 521) and LAA nonexclusion group (n = 339) according to whether concurrent surgical exclusion of the LAA was to be undertaken or not before surgery in a blind fashion. MVR was performed by two experienced surgeons. The LAA was explored during the operation and mural thrombus removed in all cases. The LAA was left intact in nonocclusion group whereas the neck of the LAA was closed with a two-layer continued suture in exclusion group. The incidence of early postoperative ischemic stroke between the two groups was compared. Results: The patients' age was 53 ± 12 years, with 48.1% male and 67.9% with rheumatic disease. Mural thrombosis was seen in 18.8% of the patients and atrial fibrillation (AF) coexisted in 62.4%. All operations were successfully performed and no difference was noted in in-hospital mortality, re-exploration for bleeding, and other major complications between the two groups. The incidence of ischemic stroke in LAA exclusion group was significantly lower than in nonexclusion group (0.6% vs. 2.7%, p = .011). The subgroup multivariate analysis showed that LAA exclusion significantly reduced the risk of postoperative stroke in patients with AF

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Section: Discussionsupporting

confidence: 92%

Left atrial appendage exclusion is effective in reducing postoperative stroke after mitral valve replacement

et al. 2020

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“…Overall, there are mixed data on the association between LAAO and risk of POAF. Of eight studies, five found no significant difference in the rate of POAF between the LAAO and no-LAAO groups [20,25,[28][29][30]. The other three studies found a significantly higher rate of POAF in the LAAO group compared to the no-LAAO group [10,26,27].…”

Section: Is Left Atrial Appendage Occlusion Associated With a Greater...mentioning

confidence: 92%

“…The studies conducted by Almahameed et al [23] and Yao et al [10] included a subgroup analysis of only patients that did not have preexisting atrial fibrillation. Notably, the studies by Johnson et al [24] and Endo et al [25] featured over 90% of patients without preexisting atrial fibrillation (Table 2).…”

Section: Key Pointsmentioning

confidence: 99%

Routine left atrial appendage occlusion in patients undergoing cardiac surgery: a narrative review

Fatima

Dhingra

Ribeiro

et al. 2021

Current Opinion in Cardiology

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Purpose of reviewNew evidence suggests a greater prevalence of protracted postoperative atrial fibrillation (POAF) than previously recognized. The left atrial appendage (LAA) is the most common source of embolism in patients with nonvalvular atrial fibrillation. In this review, we ask whether there is evidence to support routine LAA occlusion (LAAO) in patients without preexisting atrial fibrillation undergoing cardiac surgery. Recent findingsOverall, available studies are small, inconsistent and have varying proportions of patients with and without preexisting atrial fibrillation. There is considerable discrepancy with respect to the efficacy of LAAO in reducing the risk of POAF-related stroke. Only one study reported a lower rate of stroke in the LAAO group compared with no LAAO. Two studies included a subgroup analysis of patients that developed POAF and report a significantly higher rate of stroke in patients that developed POAF and did not undergo LAAO. There are three clinical trials ongoing that are investigating prophylactic LAAO in patients undergoing cardiac surgery: ATLAS, LAA-CLOSURE and LAACS-2. SummaryThere is currently insufficient evidence to recommend routine addition of LAAO to lower the risk of postoperative stroke. Ongoing clinical trials will provide important insight into the role of routine LAAO in all patients undergoing cardiac surgery.

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“…In the LAA amputation group, the frequency of arrhythmia such as new AF after surgery (both groups: 30%) did not increase without the occurrence of adverse events, but detailed analysis of the changes such as that in BP following amputation and measurements of ANP and BNP are required. 52) …”

Section: Introductionmentioning

confidence: 99%

Evidence and Challenges in Left Atrial Appendage Management

Yamamoto

Endo

Matsushita

et al. 2022

ATCS

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It is necessary to comprehend the anatomical and histological characteristics of the atria, atrial appendage, and pulmonary vein (PV) from an embryological perspective; hence, we considered a study conducted by This review aimed to discuss the anatomical properties of the left atrial appendage (LAA), its relationship with atrial fibrillation (AF), effectiveness of LAA occlusion (LAAO), techniques, and new devices used to perform this procedure. An electronic search was performed to identify studies, in the English language, on LAA management. Searches were performed on PubMed Central, Scopus, and Medline from the dates of database inception to February 2020. For the assessed papers, data were extracted from the reviewed text, tables, and figures, by two independent authors. Anticoagulant therapy for patients with AF has proven beneficial and is highly recommended, but it is challenging for many patients to maintain optimal treatment. Surgery is the most cost-effective option; surgical methods include simple LAA resection, thoracoscopic surgery, and catheter treatment. Each procedure has its advantages and disadvantages, and many prospective studies have been conducted to evaluate various treatment methods. In managing the LAA, dissection of the LAA, such as changes in its shape and size due to remodeling during AF, changes in autonomic nerve function, and thrombosis, must be understood anatomically and physiologically. We believe that early treatment intervention for the LAA should be considered particularly in cases of recurrent AF.

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The impact of surgical left atrial appendage amputation/ligation on stroke prevention in patients undergoing off-pump coronary artery bypass grafting

Cited by 11 publications

References 46 publications

Left atrial appendage exclusion is effective in reducing postoperative stroke after mitral valve replacement

Left atrial appendage exclusion is effective in reducing postoperative stroke after mitral valve replacement

Routine left atrial appendage occlusion in patients undergoing cardiac surgery: a narrative review

Evidence and Challenges in Left Atrial Appendage Management

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