Research Progress of Left atrial Appendage Intervention in Surgical Treatment of Atrial Fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HANJin-song ,  WANGHui-shan

Department of Cardiovascular Surgery, General Hospital of Shenyang Military Command, Shenyang 110016, P. R. China;

Corresponding author：

WANGHui-shan, Email: huishanwang@hotmail.com

Keywords：

Left atrial appendage; Atrial fibrillation; Maze procedure; Cardiac surgery

DOI：

10.7507/1007-4848.20150021

Video：

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It is widely believed that thrombus detachment from left atrial appendage (LAA) is closely related to cerebral embolism in patients with the increased risk of stroke in atrial fibrillation (AF) patients. About 30% AF is generated in LAA. Thus, LAA intervention may reduce the thromboembolism and AF recurrence in AF patients. Currently, more and more physicians are interested in LAA intervention for the treatment of AF. This review focuses on research progress of the LAA intervention in surgical treatment of AF.

Citation： HANJin-song, WANGHui-shan. Research Progress of Left atrial Appendage Intervention in Surgical Treatment of Atrial Fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 75-79. doi: 10.7507/1007-4848.20150021 Copy

1.	Al-Saady NM, Obel OA, Camm AJ. Left atrial appendage:structure, function, and role in thromboembolism. Heart, 1999, 82(5):547- 554.
2.	Qamruddin S, Shinbane J, Shriki J, et al. Left atrial appendage:structure, function, imaging modalities and therapeutic options. Expert Rev Cardiovasc Ther, 2010, 8(1):65-75.
3.	Donal E, Yamada H, Leclercq C, et al. The left atrial appendage, a small, blind-ended structure:a review of its echocardiographic evaluation and its clinical role. Chest, 2005, 128(3):1853-1862.
4.	Ono K, Iwama M, Kawasaki M, et al. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation. Cardiovasc Ultrasound, 2012, 10:50.
5.	Goldman ME, Pearce LA, Hart RG, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation:I. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation[SPAF-Ⅲ] study). J Am Soc Echocardiogr, 1999, 12(12):1080-1087.
6.	Kimura T, Takatsuki S, Inagawa K, et al. Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores. Heart Rhythm, 2013, 10(6):921-925.
7.	Leal S, Moreno R, de Sousa AM, et al. Evidence-based percutaneous closure of the left atrial appendage in patients with atrial fibrillation. Curr Cardiol Rev, 2012, 8(1):37-42.
8.	Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation):developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 2006, 114(7):e257-e354.
9.	Syed TM, Halperin JL. Left atrial appendage closure for stroke prevention in atrial fibrillation:state of the art and current challenges. Nat Clin Pract Cardiovasc Med, 2007, 4(8):428-435.
10.	Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage:an underrecognized trigger site of atrial fibrillation. Circulation, 2010, 122(2):109-118.
11.	Onalan O, Crystal E. Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation. Stroke, 2007, 38(2 Suppl):624-630.
12.	Madden JL. Resection of the left auricular appendix:a prophylaxis for recurrent arterial emboli. J Am Med Assoc, 1949, 140(9):769-772.
13.	Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease):endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 2008, 118(15):e523-e661.
14.	Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation:An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Europace, 2012, 14(10):1385-1413.
15.	January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014 Mar 28. pii:S0735-1097(14)01740-9. doi:10.1016/j. jacc. 2014.03.022.[Epub ahead of print].
16.	Kamohara K,Fukamachi K,Ootaki Y,et a1.A novel device for left atrial appendage exclusion.J Thorac Cardiovasc Surg,2005, 130(6):1639-1644.
17.	Kamohara K, Fukamachi K, Ootaki Y, et al. Evaluation of a novel device for left atrial appendage exclusion:The second-generation atrial exclusion device. J Thorac Cardiovasc Surg, 2006, 132(2):340-346.
18.	Salzberg SP, Gillinov AM, Anyanwu A, et al. Surgical left atrial appendage occlusion:evaluation of a novel device with magnetic resonance imaging. Eur J Cardiothorac Surg, 2008, 34(4):766-770.
19.	Fumoto H, Gillinov AM, Ootaki Y, et al. A novel device for left atrial appendage exclusion:the third-generation atrial exclusion device. J Thorac Cardiovasc Surg, 2008, 136(4):1019-1027.
20.	Almahameed ST, Khan M, Zuzek RW, et al. Left atrial appendage exclusion and the risk of thromboembolic events following mitral valve surgery. J Cardiovasc Electrophysiol, 2007, 18(4):364-366.
21.	Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3):797-802.
22.	Bakhtiary F, Kleine P, Martens S, et al. Simplified technique for surgical ligation of the left atrial appendage in high-risk patients. J Thorac Cardiovasc Surg, 2008, 135(2):430-431.
23.	Kim R, Baumgartner N, Clements J. Routine left atrial appendage ligation during cardiac surgery may prevent postoperative atrial fibrillation-related cerebrovascular accident. J Thorac Cardiovasc Surg, 2013, 145(2):582-589.
24.	Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure:assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11):924-929.
25.	Badhwar V, Rovin JD, Davenport G, et al. Left Atrial Reduction Enhances Outcomes of Modified Maze Procedure for Permanent Atrial Fibrillation During Concomitant Mitral Surgery. Ann Thorac Surg, 2006, 82(5):1758-1764.
26.	Chatterjee S, Alexander JC, Pearson PJ, et al. Left atrial appendage occlusion:lessons learned from surgical and transcatheter experiences. Ann Thorac Surg, 2011, 92(6):2283-2292.
27.	Hernandez-Estefania R, Levy Praschker B, Bastarrika G, et al. Left atrial appendage occlusion by invagination and double suture technique. Eur J Cardiothoracic Surg, 2012, 41(1):134-136.
28.	Salzberg SP, Plass A, Emmert MY, et al. Left atrial appendage clip occlusion:early clinical results. J Thorac Cardiovasc Surg, 2010, 139(5):1269-1274.
29.	Ailawadi G, Gerdisch MW, Harvey RL, et al. Exclusion of the left atrial appendage with a novel device:early results of a multicenter trial. J Thorac Cardiovasc Surg, 2011, 142(5):1002-1009.
30.	Starcka CT, Steffelb J, Emmerta MY, et al. Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage. Inter CardioVasc Thorac Surg, 2012, 15(3):416-418.
31.	Gillinov AM, Pettersson G, Cosgrove DM, et al. Stapled excision of the left atrial appendage. J Thorac Cardiovasc Surg, 2005, 129(3):679-680.
32.	Slater AD, Tatooles AJ, Coffey A, et al. Prospective Clinical Study of a Novel Left Atrial Appendage Occlusion Device. Ann Thorac Surg, 2012, 93(6):2035-2040.
33.	Dawson AG, Asopa S, Dunning J. Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion? Interact CardioVasc Thorac Surg, 2010, 10(2):306-311.
34.	Zateyshchikov DA, Brovkin AN, Chistiakov DA, et al. Advanced age, low left atrial appendage velocity, and factor V promoter sequence variation as predictors of left atrial thrombosis in patients with nonvalvular atrial fibrillation. J Thromb Thrombolysis, 2010, 30(2):192-199.
35.	Koz C, Baysan O, Yokusoglu M, et al. Left atrial appendage can still cause clinical events after ligation. Eur J Echocardiography, 2008, 9(1):194-195.
36.	Buber J, Luria D, Sternik L, et al. Left atrial contractile function following a successful modified Maze procedure at surgery and the risk for subsequent thromboembolic stroke. J Am Coll Cardiol, 2011, 58(15):1614-1621.
37.	Tilz RR, Schmidt B, Menon SD, et al. Left atrial appendage function and clinical outcome after electrical isolation of left atrial appendage in patients undergoing atrial fibrillation ablation. Circulation, 2008, 118:S694-S695.
38.	Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure:assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11):924-929.
39.	Adams C, Bainbridge D, Goela A, et al. Assessing the immediate and sustained effectiveness of circular epicardial surgical ligation of the left atrial appendage. J Card Surg, 2012, 27(2):270-273.
40.	Bartus K, Bednarek J, Myc J, et al. Feasibility of closed-chest ligation of the left atrial appendage in humans. Heart Rhythm, 2011, 8(2):188-193.
41.	Ailawadi G, Gerdisch MW, Harvey RL, et al. Exclusion of the left atrial appendage with a novel device:early results of a multicenter trial. J Thorac Cardiovasc Surg, 2011, 142(5):1002-1009.
42.	Pagé P, CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010:surgical therapy. Can J Cardiol, 2011, 27(1):67-73.
43.	Healey JS, Crystal E, Lamy A, et al. Left Atrial appendage occlusion study (LAAOS):Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am Heart J, 2005, 150(2):288-293.
44.	Badhwar V, Rovin JD, Davenport G, et al. Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery. Ann Thorac Surg, 2006, 82(5):1758-1763.
45.	Gaynor SL, Schuessler RB, Bailey MS, et al. Surgical treatment of atrial fibrillation:predicators of late recurrence.J Thorac Cardiovasc Surg, 2005, 129(1):104-111.
46.	Bayard YL, Omran H, Neuzil P, et al. PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) for prevention of cardioembolic stroke in non-anticoagulation eligible atrial fibrillation patients:results from the European PLAATO study. Euro Intervention, 2010, 6(2):220-226.
47.	Calkins H, Brugada J, Packer DL, et a1. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for personnel, policy, procedures and follow-up. Heart Rhythm, 2007, 4(6):816-861.

1. Al-Saady NM, Obel OA, Camm AJ. Left atrial appendage:structure, function, and role in thromboembolism. Heart, 1999, 82(5):547- 554.
2. Qamruddin S, Shinbane J, Shriki J, et al. Left atrial appendage:structure, function, imaging modalities and therapeutic options. Expert Rev Cardiovasc Ther, 2010, 8(1):65-75.
3. Donal E, Yamada H, Leclercq C, et al. The left atrial appendage, a small, blind-ended structure:a review of its echocardiographic evaluation and its clinical role. Chest, 2005, 128(3):1853-1862.
4. Ono K, Iwama M, Kawasaki M, et al. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation. Cardiovasc Ultrasound, 2012, 10:50.
5. Goldman ME, Pearce LA, Hart RG, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation:I. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation[SPAF-Ⅲ] study). J Am Soc Echocardiogr, 1999, 12(12):1080-1087.
6. Kimura T, Takatsuki S, Inagawa K, et al. Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores. Heart Rhythm, 2013, 10(6):921-925.
7. Leal S, Moreno R, de Sousa AM, et al. Evidence-based percutaneous closure of the left atrial appendage in patients with atrial fibrillation. Curr Cardiol Rev, 2012, 8(1):37-42.
8. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation):developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 2006, 114(7):e257-e354.
9. Syed TM, Halperin JL. Left atrial appendage closure for stroke prevention in atrial fibrillation:state of the art and current challenges. Nat Clin Pract Cardiovasc Med, 2007, 4(8):428-435.
10. Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage:an underrecognized trigger site of atrial fibrillation. Circulation, 2010, 122(2):109-118.
11. Onalan O, Crystal E. Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation. Stroke, 2007, 38(2 Suppl):624-630.
12. Madden JL. Resection of the left auricular appendix:a prophylaxis for recurrent arterial emboli. J Am Med Assoc, 1949, 140(9):769-772.
13. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease):endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 2008, 118(15):e523-e661.
14. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation:An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Europace, 2012, 14(10):1385-1413.
15. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014 Mar 28. pii:S0735-1097(14)01740-9. doi:10.1016/j. jacc. 2014.03.022.[Epub ahead of print].
16. Kamohara K,Fukamachi K,Ootaki Y,et a1.A novel device for left atrial appendage exclusion.J Thorac Cardiovasc Surg,2005, 130(6):1639-1644.
17. Kamohara K, Fukamachi K, Ootaki Y, et al. Evaluation of a novel device for left atrial appendage exclusion:The second-generation atrial exclusion device. J Thorac Cardiovasc Surg, 2006, 132(2):340-346.
18. Salzberg SP, Gillinov AM, Anyanwu A, et al. Surgical left atrial appendage occlusion:evaluation of a novel device with magnetic resonance imaging. Eur J Cardiothorac Surg, 2008, 34(4):766-770.
19. Fumoto H, Gillinov AM, Ootaki Y, et al. A novel device for left atrial appendage exclusion:the third-generation atrial exclusion device. J Thorac Cardiovasc Surg, 2008, 136(4):1019-1027.
20. Almahameed ST, Khan M, Zuzek RW, et al. Left atrial appendage exclusion and the risk of thromboembolic events following mitral valve surgery. J Cardiovasc Electrophysiol, 2007, 18(4):364-366.
21. Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3):797-802.
22. Bakhtiary F, Kleine P, Martens S, et al. Simplified technique for surgical ligation of the left atrial appendage in high-risk patients. J Thorac Cardiovasc Surg, 2008, 135(2):430-431.
23. Kim R, Baumgartner N, Clements J. Routine left atrial appendage ligation during cardiac surgery may prevent postoperative atrial fibrillation-related cerebrovascular accident. J Thorac Cardiovasc Surg, 2013, 145(2):582-589.
24. Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure:assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11):924-929.
25. Badhwar V, Rovin JD, Davenport G, et al. Left Atrial Reduction Enhances Outcomes of Modified Maze Procedure for Permanent Atrial Fibrillation During Concomitant Mitral Surgery. Ann Thorac Surg, 2006, 82(5):1758-1764.
26. Chatterjee S, Alexander JC, Pearson PJ, et al. Left atrial appendage occlusion:lessons learned from surgical and transcatheter experiences. Ann Thorac Surg, 2011, 92(6):2283-2292.
27. Hernandez-Estefania R, Levy Praschker B, Bastarrika G, et al. Left atrial appendage occlusion by invagination and double suture technique. Eur J Cardiothoracic Surg, 2012, 41(1):134-136.
28. Salzberg SP, Plass A, Emmert MY, et al. Left atrial appendage clip occlusion:early clinical results. J Thorac Cardiovasc Surg, 2010, 139(5):1269-1274.
29. Ailawadi G, Gerdisch MW, Harvey RL, et al. Exclusion of the left atrial appendage with a novel device:early results of a multicenter trial. J Thorac Cardiovasc Surg, 2011, 142(5):1002-1009.
30. Starcka CT, Steffelb J, Emmerta MY, et al. Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage. Inter CardioVasc Thorac Surg, 2012, 15(3):416-418.
31. Gillinov AM, Pettersson G, Cosgrove DM, et al. Stapled excision of the left atrial appendage. J Thorac Cardiovasc Surg, 2005, 129(3):679-680.
32. Slater AD, Tatooles AJ, Coffey A, et al. Prospective Clinical Study of a Novel Left Atrial Appendage Occlusion Device. Ann Thorac Surg, 2012, 93(6):2035-2040.
33. Dawson AG, Asopa S, Dunning J. Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion? Interact CardioVasc Thorac Surg, 2010, 10(2):306-311.
34. Zateyshchikov DA, Brovkin AN, Chistiakov DA, et al. Advanced age, low left atrial appendage velocity, and factor V promoter sequence variation as predictors of left atrial thrombosis in patients with nonvalvular atrial fibrillation. J Thromb Thrombolysis, 2010, 30(2):192-199.
35. Koz C, Baysan O, Yokusoglu M, et al. Left atrial appendage can still cause clinical events after ligation. Eur J Echocardiography, 2008, 9(1):194-195.
36. Buber J, Luria D, Sternik L, et al. Left atrial contractile function following a successful modified Maze procedure at surgery and the risk for subsequent thromboembolic stroke. J Am Coll Cardiol, 2011, 58(15):1614-1621.
37. Tilz RR, Schmidt B, Menon SD, et al. Left atrial appendage function and clinical outcome after electrical isolation of left atrial appendage in patients undergoing atrial fibrillation ablation. Circulation, 2008, 118:S694-S695.
38. Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure:assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11):924-929.
39. Adams C, Bainbridge D, Goela A, et al. Assessing the immediate and sustained effectiveness of circular epicardial surgical ligation of the left atrial appendage. J Card Surg, 2012, 27(2):270-273.
40. Bartus K, Bednarek J, Myc J, et al. Feasibility of closed-chest ligation of the left atrial appendage in humans. Heart Rhythm, 2011, 8(2):188-193.
41. Ailawadi G, Gerdisch MW, Harvey RL, et al. Exclusion of the left atrial appendage with a novel device:early results of a multicenter trial. J Thorac Cardiovasc Surg, 2011, 142(5):1002-1009.
42. Pagé P, CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010:surgical therapy. Can J Cardiol, 2011, 27(1):67-73.
43. Healey JS, Crystal E, Lamy A, et al. Left Atrial appendage occlusion study (LAAOS):Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am Heart J, 2005, 150(2):288-293.
44. Badhwar V, Rovin JD, Davenport G, et al. Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery. Ann Thorac Surg, 2006, 82(5):1758-1763.
45. Gaynor SL, Schuessler RB, Bailey MS, et al. Surgical treatment of atrial fibrillation:predicators of late recurrence.J Thorac Cardiovasc Surg, 2005, 129(1):104-111.
46. Bayard YL, Omran H, Neuzil P, et al. PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) for prevention of cardioembolic stroke in non-anticoagulation eligible atrial fibrillation patients:results from the European PLAATO study. Euro Intervention, 2010, 6(2):220-226.
47. Calkins H, Brugada J, Packer DL, et a1. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for personnel, policy, procedures and follow-up. Heart Rhythm, 2007, 4(6):816-861.

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