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Title: Assessment of the effectiveness of procedures closing the left atrium appendage in thromboembolism prophylaxis in a group of patients at increased risk of stroke


Atrial fibrillation increases the risk of stroke five-fold. The most common site of intracardiac thrombus formation in patients with AF is the left atrial appendage (LAA), where more than 90% of embolic thrombi are found. Percutaneous LAA closure procedure became an alternative method for stroke prevention in patients with non‐valvular atrial fibrillation intolerant to long term oral anticoagulation therapy. Percutaneous LAAC procedures may be divided into endocardial and epicardial approaches. Previous studies show that LAA closure is associated with good short- and midterm results. Unfortunately, there are no recent analyses of the causes of death and clinical outcomes of high-risk patients undergoing LAA closure. Aim The primary aim of this study was to assess the effectiveness and safety of the LAA closure in patients with high risk of thromboembolism and to evaluate survival free of any serious adverse events and of any‑cause death in long term observation. The secondary objective was to analyze the results of treatment with a novel occluder. In addition, a comparison was made between endocardial LAA occlusion (LAAO) and epicardial LAA closure (LAAC). Materials and methods A retrospective observational study was performed on 223 consecutive patients with nonvalvular AF, who underwent LAA closure with the LAmbre, Amplatzer or Lariat system in two centers: Department of ; Cardiac Surgery, Regional Specialist Hospital, Grudziadz and Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College. The follow-up period was over 24 months Results summary LAA closure is associated with good short- and medium-term outcomes, even in high-risk patients. Both endocardial and epicardial procedures effectively reduce the risk of thromboembolism, ranging from 69% for LAAO to 91% for LAAC at long-term follow-up. When LAA with technically difficult anatomy is found, consideration should be given to the use of advanced devices such as the LAmbre occluder, which are safe and comparable in efficacy to other occluders. LAA occlusion treatments not only reduce the risk of ischemic stroke, but also reduce mortality due to cardiovascular disease. After LAA closure, mortality after the procedure was predominantly due to noncardiovascular causes. In patients at increased risk of thromboembolism and bleeding, the most important complication requiring hospitalization was severe gastrointestinal bleeding, which occurred most frequently in the first 6 months after the procedure.

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Level of degree:

2 - studia doktoranckie

Degree grantor:

Rada Dyscypliny Nauki medyczne


Litwinowicz, Radosław

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pol; eng

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tylko w bibliotece

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Apr 30, 2024

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Apr 30, 2024

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UJCM0c69416d4ca24999b0ac7d8abec89425 Apr 30, 2024


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