title: Left atrial appendage exclusion-Where do we stand?
abstract: Atrial fibrillation (AF) is consider to be the most common cardiac arrhythmia with an increasingly prevalence. It is postulated that the source of thromboembolism in 90% of patients with non-valvular AF arises from the left atrial appendage (LAA). Stroke is the most feared and life threatening consequence of thromboembolism. Oral anticoagulation (OAC) with vitamin-K-antagonists is the standard medical therapy for stroke prevention in patients with AF. Unfortunately, chronic therapy with vitamin-K-antagonists is contraindicated in 14% to 44% of patients with AF who are at risk for stroke, and its benefits are limited by underutilization, narrow therapeutic window and increased risk for bleeding, making it often undesired. Therefore, mechanical LAA exclusion is a means of preventing thrombus formation in the appendage and subsequent thromboembolic events in these patients. The LAA can be excluded from the systemic circulation via surgical, percutaneous, or thoracoscopic approaches. Several studies of percutaneous transcatheter delivery of dedicated LAA exclusion devices, such as the percutaneous left atrial appendage transcatheter occlusion (PLAATO) device, Watchman device and the Amplatzer cardiac plug, have shown encouraging results as an alternative to vitamin-K-antagonists therapy for selected patients, good feasibility and efficacy, with a high rate of successful implantation. We discuss the current evidence for LAA exclusion in patients and review their results.
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Timothy
authors.initials: T
authors.lastname: Sakellaridis
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Mihalis
authors.initials: M
authors.lastname: Argiriou
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Charitos
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Kosmas
authors.initials: K
authors.lastname: Tsakiridis
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Katsikogiannis
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Kougioumtzi
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Machairiotis
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Tsiouda
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Stamatis
authors.initials: S
authors.lastname: Arikas
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mpakas
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Thomas
authors.initials: T
authors.lastname: Beleveslis
authors.forename: Thomas
authors.initials: T
authors.lastname: Beslevis
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Alexander
authors.initials: A
authors.lastname: Koletas
authors.affiliation: 1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zarogoulidis
keywords: Left atrial appendage (LAA); atrial fibrillation (AF); device implantation; exclusion; ligation; oral anticoagulation (OAC)