Reduced Incidence of Thromboembolic Events after Surgical Closure of Left Atrial Appendage in Patients with Atrial Fibrillation

2016 ◽  
Vol 11 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Manuel Wilbring ◽  
Friedrich Jung ◽  
Christoph Weber ◽  
Klaus Matschke ◽  
Michael Knaut
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Thromboembolic Events ◽  
Surgical Ablation ◽  
Closure Group ◽  
Laa Closure

Objective Most of the detected thrombi in patients with atrial fibrillation (AF) can be found in the left atrial appendage (LAA). Interventional LAA closure recently proved to be noninferior to warfarin therapy. Whether these results can be fully translated into surgical LAA closure remains unclear. Corresponding data are still lacking. The present observational study evaluated the impact of surgical LAA closure in patients with AF undergoing cardiac surgery on postoperative thromboembolic events. Methods A prospective registry enrolled 398 patients with permanent AF undergoing cardiac surgery. Concomitant procedures were isolated surgical ablation (group I, n = 71), isolated LAA closure (group II, n = 44), and combined surgical ablation and LAA closure (group III, n = 196). The control group consisted of 87 patients without concomitant surgical ablation or LAA closure. One-year follow-up was completed in all patients. End points were thromboembolic events and death from any cause. Results Clinical baseline characteristics were comparable among the groups. General hospital mortality was 5.5% and likewise differed not significantly. Postoperatively, mean (SD) CHAD2S2-VASc score of 3.5 (1.3) differed not significantly among the groups, indicating comparable thromboembolic risk. Follow-up referred to all hospital survivors (n = 376). Herein, overall incidence of thromboembolic events was 9.8% (n = 37), with an associated mortality of 41.0%. Patients with LAA closure alone or in combination with surgical ablation had a significantly reduced incidence of thromboembolic events (6.6% vs 20.5%, P < 0.01) and consecutively improved survival after 1 year of follow-up (7.0% vs 17.1%, P < 0.01). Conclusions Left atrial appendage closure alone or in combination with surgical ablation was associated with a significantly reduced rate of thromboembolic events and consecutively improved survival after 1 year of follow-up.

Stand-Alone Thoracoscopic Left Atrial Appendage Closure in Nonvalvular Atrial Fibrillation Patients at High Bleeding Risk

2020 ◽  
Vol 15 (6) ◽  
pp. 541-546
Author(s):  
Marco Franciulli ◽  
Giuseppe De Martino ◽  
Mariateresa Librera ◽  
Ahmed Desoky ◽  
Antonio Mariniello ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Nonvalvular Atrial Fibrillation ◽  
High Bleeding Risk ◽  
Laa Closure

Objective In nonvalvular atrial fibrillation (AF) patients at high bleeding risk, oral anticoagulants (OAC) may be contraindicated, and percutaneous left atrial appendage (LAA) closure has been advocated. However, following percutaneous procedure, either OAC or dual antiplatelet treatment is required. In this study, we present our experience in treating nonvalvular AF patients at high bleeding risk with thoracoscopic LAA closure with no subsequent antithrombotic therapy. Methods From April 2019 to January 2020, 20 consecutive AF patients, mean age 75.1 years, 16 (80%) males, underwent thoracoscopic LAA closure as a stand-alone procedure, using an epicardial clip device. OAC and antiplatelet therapy were contraindicated. Mean CHA2DS2-VASc score was 3.61, and the mean HAS-BLED score was 4.42. Successful LAA closure was assessed by transesophageal echocardiography. Primary endpoints were complete LAA closure (no residual LAA flow), operative complications, and all-cause mortality; secondary endpoints were 30-day and 6-month complications (death, ischemic stroke, hemorrhagic stroke, transient ischemic attack, any bleeding). Mean follow-up was 6 ± 4 months. Results Complete LAA closure was achieved in all patients. No operative clip-related complications or deaths occurred. At follow-up, freedom from postoperative complications was 95% and from any cerebrovascular events was 100%. Overall survival rate was 100%. Conclusions In nonvalvular AF patients at high bleeding risk (HAS-BLED score >3), thoracoscopic LAA closure appears to be a valid alternative to percutaneous techniques not requiring dual antiplatelet or OAC treatment. Apparently, external LAA clipping minimizes the risk of thromboembolic events as compared with percutaneous procedures.

scholarly journals Left Atrial Appendage Circular RNAs Are New Predictors of Atrial Fibrillation Recurrence After Surgical Ablation in Valvular Atrial Fibrillation Patients: a Case Control Study

2021 ◽  
Author(s):  
Xiyu Zhu ◽  
Yali Wang ◽  
Ran Mo ◽  
Hoshun Chong ◽  
Hailong Cao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Model ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Circular Rnas ◽  
Atrial Fibrillation Recurrence ◽  
Surgical Ablation ◽  
Kaplan Meier

Abstract Background: Atrial fibrillation recurrence after surgical ablation in valvular atrial fibrillation patients will increase the mortality and morbidity during follow-up. In this study, we attempted to evaluate the relationship between circular RNAs in left atrial appendage and atrial fibrillation recurrence to establish a predictive model for early intervention.Methods: A retrospective case control study of all patients who underwent surgical ablation during valve surgery was performed. The expression level of circular RNAs were detected in the left atrial appendage tissue after surgery. 24 hours Holter examination was used to evaluate the status of heart rhythm during follow-up. The independent risk factors of atrial fibrillation recurrence were analyzed by multivariate analysis. The predictive model of atrial fibrillation recurrence was visualized by Nomogram and was tested by receiver operating characteristic curve analysis. Kaplan-Meier analysis was performed to compare the rate of freedom from atrial fibrillation recurrence after surgery.Results: A total of 136 patients completed the research strategy from September 2018 to June 2019, 81 (59.6%) patients restored sinus rhythm and 55 (40.4%) patients experienced atrial fibrillation recurrence. Increased age (P=0.002), longer AF duration (P<0.001) and increased expression of circ 81906-RYR2 (P<0.001), circ 44782-LAMA2 (P=0.002), circ 418-KCNN2 (P=0.011) and circ 35880-ANO5 (P<0.001) were detected in atrial fibrillation recurrence group. Multivariate analysis revealed that increased age (odd ratio=1.072, P=0.006), longer AF duration (odd ratio=1.007, P=0.036) and increased expression of circ 81906-RYR2 (odd ratio=2.210, P<0.001) were independent risk factors for recurrence. The area under the curve was 0.77 and the cut-off value was 70 points of the predictive model. The results of Kaplan-Meier plots showed that patients over 70 points were more likely to suffer from atrial fibrillation recurrence during the follow-up.Conclusions: Circ 81906-RYR2 could be a new predictor of atrial fibrillation recurrence after surgical ablation. A predictive model consists of age, atrial fibrillation duration and expression of circ 81906-RYR2 was alternative for early intervention of atrial fibrillation recurrence.Trial registration: Retrospectively registered.

scholarly journals Long-Term Outcomes of Left Atrial Appendage Electrical Isolation in Patients With Nonparoxysmal Atrial Fibrillation

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Jorge Romero ◽  
Luigi Di Biase ◽  
Sanghamitra Mohanty ◽  
Chintan Trivedi ◽  
Kavisha Patel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Propensity Score ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Thromboembolic Events

Background: Left atrial appendage electrical isolation (LAAEI) has been proposed for the treatment of nonparoxysmal atrial fibrillation (AF). The long-term clinical outcomes of this approach remain unclear. The objective of our study was to investigate the incremental benefit and safety of LAAEI in patients undergoing catheter ablation for nonparoxysmal AF. Methods: Propensity score-matched analysis was performed using a prospective registry database from 2010 to 2014. All patients in the LAAEI group were matched based on baseline characteristics, echocardiographic parameters, and procedural ablation techniques. Results: We identified 1842 patients who underwent catheter ablation for nonparoxysmal AF. Propensity score matching yielded 1092 patients, 546 patients with LAAEI, and 546 patients without LAAEI. At 5-year follow-up, overall freedom from all-atrial arrhythmia recurrence, off-antiarrhythmic drugs, in patients who underwent LAAEI was 68.9% versus 50.2% in those who underwent standard ablation alone ( P <0.001). Acute complication rates were similar between groups (LAAEI 1.3% versus non-LAAEI 0.73%, P =0.36). At 5-year follow-up, 382 (70%) patients in the LAAEI group remained on oral anticoagulation versus 217 (39.7%) in the non-LAAEI group. At 5-year follow-up, thromboembolic events occurred in 15/546 (2.75%) in the LAAEI group and 4/546 (0.73%) in the non-LAAEI group ( P =0.01). No thromboembolic events occurred in either group on-oral anticoagulation. In patients who were off-oral anticoagulation, at 5-year follow-up, thromboembolic events occurred in 15/164 (9.1%) in the LAAEI group and 4/329 (1.2%) in the non-LAAEI group ( P <0.001). Conclusions: At 5-year follow-up, LAAEI was associated with significantly higher freedom from all-atrial arrhythmia recurrence in patients with persistent and long-standing persistent AF without increasing acute procedural complication rate. In patients off-oral anticoagulation, there appears to be a higher risk of thromboembolic events in the LAAEI group.

Patients with Atrial Fibrillation Undergoing Cardiac Surgery: No Left Atrial Appendage Shall Remain Untouched

2021 ◽  
pp. 155698452110321
Author(s):  
Richard P. Whitlock ◽  
Emilie P. Belley-Cote
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Adverse Effects ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Systemic Embolism ◽  
Left Atrial Appendage Occlusion ◽  
Late Adverse Effects

The Left Atrial Appendage Occlusion Study III randomized 4,811 patients with atrial fibrillation and a CHA2DS2VASc score ≥2 undergoing cardiac surgery to surgical left atrial appendage occlusion or no occlusion. At a mean follow-up of 3.8 years, stroke or systemic embolism was reduced by 33% in the occlusion group with no evidence of early or late adverse effects. This review discusses the implication of these findings.

scholarly journals Association Between Left Atrial Appendage Occlusion and Readmission for Thromboembolism Among Patients With Atrial Fibrillation Undergoing Concomitant Cardiac Surgery

JAMA ◽  
2018 ◽  
Vol 319 (4) ◽  
pp. 365 ◽  
Author(s):  
Daniel J. Friedman ◽  
Jonathan P. Piccini ◽  
Tongrong Wang ◽  
Jiayin Zheng ◽  
S. Chris Malaisrie ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion

P4731Procedure-related acute thrombosis after surgical left atrial appendage occlusion for atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Inoue ◽  
T Shimizu ◽  
A Yoshimoto ◽  
Y Suematsu
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cardiac Ct ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Atrial Appendage ◽  
Full Cohort ◽  
Exact Test ◽  
Acute Thrombosis ◽  
Laa Closure

Abstract Background/Introduction Left atrial appendage (LAA) occlusion is an effective strategy for thromboembolism prevention in patients with atrial fibrillation (AF), and the novel methods of occlusion is various. The acute thrombosis after percutaneous LAA occlusion devices has been recently reported, but thrombus formation after surgical LAA occlusion is still unclear. Purpose This study aimed to analyse the incidence and prognosis of thrombus formation on closure stump line in patients with AF who underwent surgical LAA occlusion. Methods This study retrospectively analised the data from patients treated with two methods of surgical LAA closure, resection or clipping, from January 2014 to November 2018. Results A total of 187 consecutive patients with AF underwent surgical LAA closure (31 clipping and 156 stapler resection). 170 patients (91%) underwent cardiac CT for LAA imaging on postoperative day 2. The incidence of acute procedure-related thrombus formation in full cohort was 19% (35 cases). The incidence of acute thrombus in patients with clipping and resection was 19% and 16%, respectively (Fisher's exact test, p=0.8). All of 35 patients who had thrombus on LAA closure stump line underwent cardiac CT again 3 months after the primary CT. In all patients with secondary cardiac CT, thrombus on LAA closure stump line disappeared. No symptomatic thromboembolism occurred during the follow-up from operation to secondary CT scan. Conclusion(s) Thrombus formation on stump after surgical LAA closure may often occur on acute phase. The optimal LAA imaging and anti-coagulation therapy after surgical LAA occlusion will prevent patients with acute thrombus from thromboembolism.

scholarly journals Spontaneously occluded left atrial appendage in a patient with atrial fibrillation and stroke: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-4
Author(s):  
Andreas Bugge Tinggaard ◽  
Kasper Korsholm ◽  
Jesper Møller Jensen ◽  
Jens Erik Nielsen-Kudsk
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Transoesophageal Echocardiography ◽  
Similar Efficacy ◽  
Cardiovascular Death ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion ◽  
All Cause Mortality

Abstract Background  The left atrial appendage (LAA) is the main source of thromboembolism in atrial fibrillation (AF). Transcatheter closure is non-inferior to warfarin therapy in preventing stroke. Case summary  A patient with two consecutive strokes associated with AF was referred for transcatheter LAA occlusion (LAAO). Preprocedural cardiac CT and transoesophageal echocardiography demonstrated a spontaneously occluded LAA with a smooth left atrial surface, with stationary results at 6- and 12-month imaging follow-up. Warfarin was discontinued, and life-long aspirin instigated. Discussion  Left atrial appendage occlusion has shown non-inferiority to warfarin for prevention of stroke, cardiovascular death, and all-cause mortality. No benefits from anticoagulation have been demonstrated in patients with embolic stroke of undetermined source. In the present case, we observed that the LAA was occluded and, therefore, treated with aspirin monotherapy assuming similar efficacy as transcatheter LAAO.

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