SynthesisEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2026
Methods and Criteria for Evaluating the Success of Surgical Left Atrial Appendage Closure: A Systematic Review.
Synthesis in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesSurgical left atrial appendage closure (LAAC) is recommended as a concomitant procedure during cardiac surgery in patients with atrial fibrillation to reduce stroke risk, but the methods and criteria used to evaluate procedural success remain poorly standardized. This systematic review aims to identify and describe the imaging modalities, evaluation criteria, and validation methods used to assess the success of surgical LAAC.
methodsA systematic literature search was conducted in Embase, MEDLINE, and the Cochrane Library. Clinical studies reporting intraoperative or postoperative evaluation of surgical LAAC were included. Data were extracted on imaging modality, timing of assessment, criteria for procedural success, measurement techniques, validation efforts, and reported success rates.
resultsEighty studies comprising 7517 patients and 10 375 imaging examinations were included. Transesophageal echocardiography was the most frequently used imaging modality (83%), primarily for intraoperative assessment, while cardiac computed tomography was used in 44% of studies for postoperative evaluation. Seventeen different definitions of procedural success were identified. The most commonly applied definitions were absence of persistent flow between the left atrium and LAA and a residual stump length <10 mm. The overall procedural success rate across all modalities, timings, and criteria was 92.8%. Success rates were highest intraoperatively (96.8%) and declined with increasing postoperative time.
conclusionsThere is substantial heterogeneity in the evaluation of procedural success following surgical LAAC. The lack of standardized imaging protocols and success definitions limits comparability across studies and interpretation of reported clinical outcomes. Establishing uniform evaluation criteria is essential to improve reproducibility and to clarify the relationship between technical success and clinical benefit. PROSPERO REGISTRATION NUMBER: Prospective Register of Systematic Reviews in Health and Social Care (PROSPERO) registration number: CRD42024617540.
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