Amputation of the Canine Atrial Appendages.

Hellerstein, Herman K.; Sinaiko, E.; Dolgin, Martin

doi:10.3181/00379727-66-16084p

Cited by 27 publications

(10 citation statements)

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“…Hellerstein was the first to show the feasibility of LAA resection in dogs [53]. The first resection of the LAA for prophylaxis of recurrent arterial embolism in men was performed in 1949 by Madden [80], followed by Beal in 1950 [6].…”

Section: Left Atrial Appendage Occlusion For Stroke Risk Reductionmentioning

confidence: 99%

Rheological and hemostasiological aspects of thrombus formation in the left atrial appendage in atrial fibrillation? A new strategy for prevention of cardioembolic stroke

Leithäuser

Jung

Park

2010

Clinical Hemorheology and Microcirculation

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Atrial fibrillation (AF), as the most common cardiac rhythm disturbance, gains in importance not only for the persons affected, but also for health care and social economy due to thromboembolic events, of which stroke is the most serious, disabling, and life threatening one. Cardiac embolism is due to thrombus formation mainly in the left atrial appendage (LAA). The pathophysiology leading to increased thrombogenicity is complex and requires a remodelling of the LAA structure, decreased LAA blood flow, activation of inflammatory processes, deviations of the hemostatic/fibrinolytic system, and activation/dysfunction of endothelial/endocardial cells. Altogether, a prothrombotic state proposed by Virchow more than 150 years ago. The presence of a LAA thrombus, therefore, is a result of a dynamic process of clot formation and lysis. A comprehensive understanding of this pathophysiology is helpful to optimize the management of patients at high risk of cardioembolic stroke. Especially those with contraindications for oral anticoagulation are in a need of an alternative approach that is not associated with a long-term risk of hemorrhage and other attendant circumstances. The reasonable alternative may be the exclusion of the LAA cavity from circulation by either surgical or percutaneous catheter-based procedures. B. Leithäuser et al. / A new strategy for prevention of cardioembolic stroke113]. There is a fivefold increased risk of stroke and thromboembolism with AF when compared to sinus rhythm [128]. On the assumption that more than 90% of all cardiac thrombi in patients with AF form in the LAA, and the fact that thrombi have been identified in 15-20% of patients with AF who have clinical risk factors for ischemic stroke [8,119], it has been deemed to be "our most lethal attachment" [60].The mechanism of thrombus formation in the LAA with subsequent embolization is undoubtedly complex. It requires a combination of abnormal blood stasis, endothelial or endocardial dysfunction and an activated state of the coagulation system, thus reflecting a pathophysiology proposed by Rudolf Virchow in 1856 and named as Virchow's triad for thrombogenesis [19].Although the incidence of thromboembolism in atrial fibrillation can be dramatically reduced with the use of anticoagulants, particularly warfarin [44,50], this option continues to be underused, even in eligible patients [16,43,45,49]. Obliteration or amputation of the LAA may help to reduce the risk of thromboembolism [8,86], above all in patients with an equally high risk of stroke and bleeding [28,36,58,74].

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Section: Left Atrial Appendage Occlusion For Stroke Risk Reductionmentioning

confidence: 99%

Rheological and hemostasiological aspects of thrombus formation in the left atrial appendage in atrial fibrillation? A new strategy for prevention of cardioembolic stroke

Leithäuser

Jung

Park

2010

Clinical Hemorheology and Microcirculation

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“…Hellerstein et al183) was the first to show the feasibility of LAA resection in dogs. The first resection of the LAA for prophylaxis of recurrent arterial embolism in men was performed in 1949 by Madden,184) followed by Beal et al185) in 1950.…”

Section: Left Atrial Appendage Occlusion For Stroke Risk Reductionmentioning

confidence: 99%

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Leithäuser

Park

2009

Korean Circ J

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Atrial fibrillation is the most common cardiac arrhythmias, and a major cause of morbidity and mortality due to cardioembolic stroke. The left atrial appendage is the major site of thrombus formation in non-valvular atrial fibrillation. Loss of atrial systole in atrial fibrillation and increased relative risk of associated stroke point strongly toward a role for stasis of blood in left atrial thrombosis, although thrombus formation is multifactorial, and much more than blood flow irregularities are implicated. Oral anticoagulation with vitamin-K-antagonists is currently the most effective prophylaxis for stroke in atrial fibrillation. Unfortunately, this treatment is often contraindicated, particularly in the elderly, in whom risk of stroke is high. Moreover, given the risk of major bleeding, there is reason to be skeptical of the net benefit when warfarin is used in those patients. This work reviews the pathophysiology of cardioembolic stroke and critically spotlights the current status of preventive anticoagulation therapy. Various techniques to exclude the left atrial appendage from circulation were discussed as a considerable alternative for stroke prophylaxis.

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“…[11][12][13] After the feasibility of canine LAA resection was shown by Hellerstein and his associates, 11 Maden 12 performed a LAA excision in two patients with AF and rheumatic mitral valve disease in 1949. In 1950, Beal et al 13 reported two cases of left and one case of right atrial appendectomy for prophylaxis of thromboembolism.…”

Section: Exclusion Of the Left Atrial Appendage During Open Chest Surmentioning

confidence: 99%

Left Atrial Appendage Exclusion for Stroke Prevention in Patients With Nonrheumatic Atrial Fibrillation

Özer

Crystal

2007

Stroke

111

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Abstract-The efficacy of oral anticoagulation (OAC) for stroke prevention in patients with nonrheumatic atrial fibrillation (AF) has clearly been established. However, a substantial number of patients with AF who are at high risk for thromboembolic events are not candidates for long-term OAC. The left atrial appendix (LAA) is the most common place of thrombosis in patients with AF, and it can easily be excluded from the systemic circulation at the time of cardiac surgery by excision, ligation, suturing, or stapling. Currently, removal of the LAA at the time of mitral valve surgery is recommended to reduce future stroke risk.

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Amputation of the Canine Atrial Appendages.

Cited by 27 publications

References 0 publications

Rheological and hemostasiological aspects of thrombus formation in the left atrial appendage in atrial fibrillation? A new strategy for prevention of cardioembolic stroke

Rheological and hemostasiological aspects of thrombus formation in the left atrial appendage in atrial fibrillation? A new strategy for prevention of cardioembolic stroke

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Left Atrial Appendage Exclusion for Stroke Prevention in Patients With Nonrheumatic Atrial Fibrillation

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