A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke
Objective The present study evaluated the differences between left atrial appendage occlusion (LAAO) and left atrial appendage resection (LAAR) in terms of the safety and efficacy. Materials and methods From January 2018 to August 2022, 94 patients underwent a stand-alone LAAO, and 90 patients under...
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| creator | Yoshimoto, Akihiro Suematsu, Yoshihiro Kurahashi, Kanan Takahashi, Hidetomi Inoue, Takafumi |
| description | Objective
The present study evaluated the differences between left atrial appendage occlusion (LAAO) and left atrial appendage resection (LAAR) in terms of the safety and efficacy.
Materials and methods
From January 2018 to August 2022, 94 patients underwent a stand-alone LAAO, and 90 patients underwent stand-alone LAAR in our institution. All of these patients were included in this study. LAAO was performed via left mini-thoracotomy, and LAAR was performed via a left thoracoscopic approach. The patients’ characteristics and perioperative and postoperative data were obtained by retrospectively reviewing their medical records.
Results
The mean age of the patients was 72.4 ± 10.2 (LAAO) and 66.2 ± 9.4 (LAAR) years old (
P
|
| doi_str_mv | 10.1007/s11748-023-01961-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2840246744</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2931053040</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-d403a2f635e0e1a8e6c855e7534ce1ea50b76ebcb53fd4551b563e2809b735883</originalsourceid><addsrcrecordid>eNp9kc9O3DAQhy0EYmHhBThUlnrhkmLHf_e4QqWttFIvcLYcZ7KEJnawHSpeoU9dw8JW6oGDZY_8zW9G-hC6oOQLJURdJUoV1xWpWUXoStKKH6ATqiWrpKLscP8mYoFOU3ogREhNxTFaMMWl1rU4QX_W2IVxsrFPweMG8m8Aj1O2vq3sEDzgAbqMbY69HbCdJvCt3QIOzg1z6ktPIXGEBC6_VglbPEK-Dy0OHZ4iPIHPvd9iZ2Pbhy343uF8H8PYBChnKGXKMfyCM3TU2SHB-du9RHc3X2-vv1ebn99-XK83lWNK5KrlhNm6k0wAAWo1SKeFACUYd0DBCtIoCY1rBOtaLgRthGRQa7JqFBNasyW63OVOMTzOkLIZ--RgGKyHMCdTa05qLhXnBf38H_oQ5ujLdqZeMUoEI2WbJap3lIshpQidmWI_2vhsKDEvpszOlCmmzKsp8xL96S16bkZo9y3vagrAdkAqX34L8d_sD2L_AgzOoH4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2931053040</pqid></control><display><type>article</type><title>A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Yoshimoto, Akihiro ; Suematsu, Yoshihiro ; Kurahashi, Kanan ; Takahashi, Hidetomi ; Inoue, Takafumi</creator><creatorcontrib>Yoshimoto, Akihiro ; Suematsu, Yoshihiro ; Kurahashi, Kanan ; Takahashi, Hidetomi ; Inoue, Takafumi</creatorcontrib><description>Objective
The present study evaluated the differences between left atrial appendage occlusion (LAAO) and left atrial appendage resection (LAAR) in terms of the safety and efficacy.
Materials and methods
From January 2018 to August 2022, 94 patients underwent a stand-alone LAAO, and 90 patients underwent stand-alone LAAR in our institution. All of these patients were included in this study. LAAO was performed via left mini-thoracotomy, and LAAR was performed via a left thoracoscopic approach. The patients’ characteristics and perioperative and postoperative data were obtained by retrospectively reviewing their medical records.
Results
The mean age of the patients was 72.4 ± 10.2 (LAAO) and 66.2 ± 9.4 (LAAR) years old (
P
< 0.05). There were no marked differences in the mean duration of atrial fibrillation (AF) or the ratio of AF type between both groups. The average CHA
2
DS
2
-Vasc scores were 4.4 ± 1.6 (LAAO) and 2.7 ± 1.8 (LAAR) (
P
< 0.05), and the average HAS-BLED scores were 2.9 ± 1.0 (LAAO) and 2.2 ± 1.2 (LAAR) (
P
< 0.05). The mean operation time was 49 ± 20 min (LAAO) and 34 ± 15 min (LAAR) (
P
< 0.05). No substantial gaps were detected in preoperative echo-graphic findings between the groups. No significant differences were observed in the amount of intraoperative or postoperative bleeding or the rate of intraoperative massive bleeding events between the groups. Successful LAA closure was achieved in all cases in both groups. Approximately 50% of patients underwent concomitant left pulmonary vein isolation (LPVI) during surgery, indicating no significant differences between the groups (
P
= 0.872). The early mortality rate was 1.04% in the LAAO group and 0% in the LAAR group (
P
= 0.132). There was no significant difference in the rate of postoperative LAA stump thrombus between the groups (8.5% in the LAAO group and 6.7% in the LAAR group;
P
= 0.320). The mean follow-up period was 851 ± 500 (6–1618) days in the LAAO group and 1208 ± 357 (49–1694) days in the LAAR group. Postoperative stroke events were detected in 1 patient in each group (
P
= 0.432). There was no significant difference in the sinus rhythm recovery rate after LPVI between these groups (31.1% in the LAAO group and 28.6% in the LAAR group;
P
= 0.763).
Conclusion
There were no significant differences between LAAO and LAAR in terms of the feasibility and the effectiveness as a method for stroke prophylaxis only to selected patients for both procedures, although further studies including the comparison between groups with the same backgrounds to confirm the authentic differences in the clinical results between these procedures.</description><identifier>ISSN: 1863-6705</identifier><identifier>EISSN: 1863-6713</identifier><identifier>DOI: 10.1007/s11748-023-01961-4</identifier><identifier>PMID: 37468825</identifier><language>eng</language><publisher>Singapore: Springer Nature Singapore</publisher><subject>Atrial Appendage - diagnostic imaging ; Atrial Appendage - surgery ; Atrial Fibrillation - complications ; Atrial Fibrillation - surgery ; Blood clots ; Cardiac arrhythmia ; Cardiac Surgery ; Cardiac Surgical Procedures ; Cardiology ; Clinical outcomes ; Ejection fraction ; Hemorrhage - prevention & control ; Humans ; Medicine ; Medicine & Public Health ; Mortality ; Original Article ; Ostomy ; Patients ; Pulmonary arteries ; Retrospective Studies ; Sinuses ; Stroke ; Stroke - complications ; Stroke - prevention & control ; Surgery ; Surgical Oncology ; Thoracic Surgery ; Veins & arteries</subject><ispartof>General thoracic and cardiovascular surgery, 2024-03, Vol.72 (3), p.157-163</ispartof><rights>The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d403a2f635e0e1a8e6c855e7534ce1ea50b76ebcb53fd4551b563e2809b735883</citedby><cites>FETCH-LOGICAL-c375t-d403a2f635e0e1a8e6c855e7534ce1ea50b76ebcb53fd4551b563e2809b735883</cites><orcidid>0000-0003-2797-641X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11748-023-01961-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11748-023-01961-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37468825$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yoshimoto, Akihiro</creatorcontrib><creatorcontrib>Suematsu, Yoshihiro</creatorcontrib><creatorcontrib>Kurahashi, Kanan</creatorcontrib><creatorcontrib>Takahashi, Hidetomi</creatorcontrib><creatorcontrib>Inoue, Takafumi</creatorcontrib><title>A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke</title><title>General thoracic and cardiovascular surgery</title><addtitle>Gen Thorac Cardiovasc Surg</addtitle><addtitle>Gen Thorac Cardiovasc Surg</addtitle><description>Objective
The present study evaluated the differences between left atrial appendage occlusion (LAAO) and left atrial appendage resection (LAAR) in terms of the safety and efficacy.
Materials and methods
From January 2018 to August 2022, 94 patients underwent a stand-alone LAAO, and 90 patients underwent stand-alone LAAR in our institution. All of these patients were included in this study. LAAO was performed via left mini-thoracotomy, and LAAR was performed via a left thoracoscopic approach. The patients’ characteristics and perioperative and postoperative data were obtained by retrospectively reviewing their medical records.
Results
The mean age of the patients was 72.4 ± 10.2 (LAAO) and 66.2 ± 9.4 (LAAR) years old (
P
< 0.05). There were no marked differences in the mean duration of atrial fibrillation (AF) or the ratio of AF type between both groups. The average CHA
2
DS
2
-Vasc scores were 4.4 ± 1.6 (LAAO) and 2.7 ± 1.8 (LAAR) (
P
< 0.05), and the average HAS-BLED scores were 2.9 ± 1.0 (LAAO) and 2.2 ± 1.2 (LAAR) (
P
< 0.05). The mean operation time was 49 ± 20 min (LAAO) and 34 ± 15 min (LAAR) (
P
< 0.05). No substantial gaps were detected in preoperative echo-graphic findings between the groups. No significant differences were observed in the amount of intraoperative or postoperative bleeding or the rate of intraoperative massive bleeding events between the groups. Successful LAA closure was achieved in all cases in both groups. Approximately 50% of patients underwent concomitant left pulmonary vein isolation (LPVI) during surgery, indicating no significant differences between the groups (
P
= 0.872). The early mortality rate was 1.04% in the LAAO group and 0% in the LAAR group (
P
= 0.132). There was no significant difference in the rate of postoperative LAA stump thrombus between the groups (8.5% in the LAAO group and 6.7% in the LAAR group;
P
= 0.320). The mean follow-up period was 851 ± 500 (6–1618) days in the LAAO group and 1208 ± 357 (49–1694) days in the LAAR group. Postoperative stroke events were detected in 1 patient in each group (
P
= 0.432). There was no significant difference in the sinus rhythm recovery rate after LPVI between these groups (31.1% in the LAAO group and 28.6% in the LAAR group;
P
= 0.763).
Conclusion
There were no significant differences between LAAO and LAAR in terms of the feasibility and the effectiveness as a method for stroke prophylaxis only to selected patients for both procedures, although further studies including the comparison between groups with the same backgrounds to confirm the authentic differences in the clinical results between these procedures.</description><subject>Atrial Appendage - diagnostic imaging</subject><subject>Atrial Appendage - surgery</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - surgery</subject><subject>Blood clots</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac Surgery</subject><subject>Cardiac Surgical Procedures</subject><subject>Cardiology</subject><subject>Clinical outcomes</subject><subject>Ejection fraction</subject><subject>Hemorrhage - prevention & control</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Pulmonary arteries</subject><subject>Retrospective Studies</subject><subject>Sinuses</subject><subject>Stroke</subject><subject>Stroke - complications</subject><subject>Stroke - prevention & control</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Thoracic Surgery</subject><subject>Veins & arteries</subject><issn>1863-6705</issn><issn>1863-6713</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9O3DAQhy0EYmHhBThUlnrhkmLHf_e4QqWttFIvcLYcZ7KEJnawHSpeoU9dw8JW6oGDZY_8zW9G-hC6oOQLJURdJUoV1xWpWUXoStKKH6ATqiWrpKLscP8mYoFOU3ogREhNxTFaMMWl1rU4QX_W2IVxsrFPweMG8m8Aj1O2vq3sEDzgAbqMbY69HbCdJvCt3QIOzg1z6ktPIXGEBC6_VglbPEK-Dy0OHZ4iPIHPvd9iZ2Pbhy343uF8H8PYBChnKGXKMfyCM3TU2SHB-du9RHc3X2-vv1ebn99-XK83lWNK5KrlhNm6k0wAAWo1SKeFACUYd0DBCtIoCY1rBOtaLgRthGRQa7JqFBNasyW63OVOMTzOkLIZ--RgGKyHMCdTa05qLhXnBf38H_oQ5ujLdqZeMUoEI2WbJap3lIshpQidmWI_2vhsKDEvpszOlCmmzKsp8xL96S16bkZo9y3vagrAdkAqX34L8d_sD2L_AgzOoH4</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Yoshimoto, Akihiro</creator><creator>Suematsu, Yoshihiro</creator><creator>Kurahashi, Kanan</creator><creator>Takahashi, Hidetomi</creator><creator>Inoue, Takafumi</creator><general>Springer Nature Singapore</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2797-641X</orcidid></search><sort><creationdate>20240301</creationdate><title>A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke</title><author>Yoshimoto, Akihiro ; Suematsu, Yoshihiro ; Kurahashi, Kanan ; Takahashi, Hidetomi ; Inoue, Takafumi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-d403a2f635e0e1a8e6c855e7534ce1ea50b76ebcb53fd4551b563e2809b735883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Atrial Appendage - diagnostic imaging</topic><topic>Atrial Appendage - surgery</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - surgery</topic><topic>Blood clots</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac Surgery</topic><topic>Cardiac Surgical Procedures</topic><topic>Cardiology</topic><topic>Clinical outcomes</topic><topic>Ejection fraction</topic><topic>Hemorrhage - prevention & control</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Pulmonary arteries</topic><topic>Retrospective Studies</topic><topic>Sinuses</topic><topic>Stroke</topic><topic>Stroke - complications</topic><topic>Stroke - prevention & control</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Thoracic Surgery</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yoshimoto, Akihiro</creatorcontrib><creatorcontrib>Suematsu, Yoshihiro</creatorcontrib><creatorcontrib>Kurahashi, Kanan</creatorcontrib><creatorcontrib>Takahashi, Hidetomi</creatorcontrib><creatorcontrib>Inoue, Takafumi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>General thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yoshimoto, Akihiro</au><au>Suematsu, Yoshihiro</au><au>Kurahashi, Kanan</au><au>Takahashi, Hidetomi</au><au>Inoue, Takafumi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke</atitle><jtitle>General thoracic and cardiovascular surgery</jtitle><stitle>Gen Thorac Cardiovasc Surg</stitle><addtitle>Gen Thorac Cardiovasc Surg</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>72</volume><issue>3</issue><spage>157</spage><epage>163</epage><pages>157-163</pages><issn>1863-6705</issn><eissn>1863-6713</eissn><abstract>Objective
The present study evaluated the differences between left atrial appendage occlusion (LAAO) and left atrial appendage resection (LAAR) in terms of the safety and efficacy.
Materials and methods
From January 2018 to August 2022, 94 patients underwent a stand-alone LAAO, and 90 patients underwent stand-alone LAAR in our institution. All of these patients were included in this study. LAAO was performed via left mini-thoracotomy, and LAAR was performed via a left thoracoscopic approach. The patients’ characteristics and perioperative and postoperative data were obtained by retrospectively reviewing their medical records.
Results
The mean age of the patients was 72.4 ± 10.2 (LAAO) and 66.2 ± 9.4 (LAAR) years old (
P
< 0.05). There were no marked differences in the mean duration of atrial fibrillation (AF) or the ratio of AF type between both groups. The average CHA
2
DS
2
-Vasc scores were 4.4 ± 1.6 (LAAO) and 2.7 ± 1.8 (LAAR) (
P
< 0.05), and the average HAS-BLED scores were 2.9 ± 1.0 (LAAO) and 2.2 ± 1.2 (LAAR) (
P
< 0.05). The mean operation time was 49 ± 20 min (LAAO) and 34 ± 15 min (LAAR) (
P
< 0.05). No substantial gaps were detected in preoperative echo-graphic findings between the groups. No significant differences were observed in the amount of intraoperative or postoperative bleeding or the rate of intraoperative massive bleeding events between the groups. Successful LAA closure was achieved in all cases in both groups. Approximately 50% of patients underwent concomitant left pulmonary vein isolation (LPVI) during surgery, indicating no significant differences between the groups (
P
= 0.872). The early mortality rate was 1.04% in the LAAO group and 0% in the LAAR group (
P
= 0.132). There was no significant difference in the rate of postoperative LAA stump thrombus between the groups (8.5% in the LAAO group and 6.7% in the LAAR group;
P
= 0.320). The mean follow-up period was 851 ± 500 (6–1618) days in the LAAO group and 1208 ± 357 (49–1694) days in the LAAR group. Postoperative stroke events were detected in 1 patient in each group (
P
= 0.432). There was no significant difference in the sinus rhythm recovery rate after LPVI between these groups (31.1% in the LAAO group and 28.6% in the LAAR group;
P
= 0.763).
Conclusion
There were no significant differences between LAAO and LAAR in terms of the feasibility and the effectiveness as a method for stroke prophylaxis only to selected patients for both procedures, although further studies including the comparison between groups with the same backgrounds to confirm the authentic differences in the clinical results between these procedures.</abstract><cop>Singapore</cop><pub>Springer Nature Singapore</pub><pmid>37468825</pmid><doi>10.1007/s11748-023-01961-4</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-2797-641X</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | General thoracic and cardiovascular surgery, 2024-03, Vol.72 (3), p.157-163 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Atrial Appendage - diagnostic imaging Atrial Appendage - surgery Atrial Fibrillation - complications Atrial Fibrillation - surgery Blood clots Cardiac arrhythmia Cardiac Surgery Cardiac Surgical Procedures Cardiology Clinical outcomes Ejection fraction Hemorrhage - prevention & control Humans Medicine Medicine & Public Health Mortality Original Article Ostomy Patients Pulmonary arteries Retrospective Studies Sinuses Stroke Stroke - complications Stroke - prevention & control Surgery Surgical Oncology Thoracic Surgery Veins & arteries |
| title | A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke |
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