{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:32:09Z","timestamp":1779204729137,"version":"3.51.4"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Surgical 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty studies comprising 7517 patients and 10\u2009375 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 &amp;lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO Registration Number<\/jats:title>\n                    <jats:p>Prospective Register of Systematic Reviews in Health and Social Care (PROSPERO) registration number: CRD42024617540.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag146","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T11:18:34Z","timestamp":1775474314000},"source":"Crossref","is-referenced-by-count":1,"title":["Methods and Criteria for Evaluating the Success of Surgical Left Atrial Appendage Closure: A Systematic Review"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8551-856X","authenticated-orcid":false,"given":"Rune","family":"Vad","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Odense University Hospital , Odense 5000,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6699-355X","authenticated-orcid":false,"given":"Kristina","family":"Gosvig","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Odense University Hospital , Odense 5000,","place":["Denmark"]},{"name":"Department of Clinical Research, Research Unit for Cardiac Surgery, University of Southern Denmark , Odense 5230,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Beetham","sequence":"additional","affiliation":[{"name":"Michael G. DeGroote School of Medicine, McMaster University , Hamilton, ON L8P 1H6,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4393-3884","authenticated-orcid":false,"given":"Nils Henrik","family":"Hansson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital , Odense 5000,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6863-5884","authenticated-orcid":false,"given":"Richard","family":"Whitlock","sequence":"additional","affiliation":[{"name":"Department of Surgery, McMaster University , Hamilton, ON L8S 1C7,","place":["Canada"]},{"name":"Population Health Research Institute, McMaster University and Hamilton Health Sciences , Hamilton, ON L8L 2X2,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6898-2715","authenticated-orcid":false,"given":"Lars Peter Sch\u00f8dt","family":"Riber","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Odense University Hospital , Odense 5000,","place":["Denmark"]},{"name":"Department of Clinical Research, Research Unit for Cardiac Surgery, University of Southern Denmark , Odense 5230,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"2026051515520527100_ezag146-B1","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1161\/CIRCULATIONAHA.119.041303","article-title":"Stroke risk as a function of atrial fibrillation duration and CHA2DS2-VASc score","volume":"140","author":"Kaplan","year":"2019","journal-title":"Circulation"},{"key":"2026051515520527100_ezag146-B2","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1161\/01.str.22.8.983","article-title":"Atrial fibrillation as an independent risk factor for stroke: the Framingham study","volume":"22","author":"Wolf","year":"1991","journal-title":"Stroke"},{"key":"2026051515520527100_ezag146-B3","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1016\/0003-4975(95)00887-x","article-title":"Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation","volume":"61","author":"Blackshear","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"2026051515520527100_ezag146-B4","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1056\/NEJMoa2101897","article-title":"Left atrial appendage occlusion during cardiac surgery to prevent stroke","volume":"384","author":"Whitlock","year":"2021","journal-title":"N Engl J Med"},{"key":"2026051515520527100_ezag146-B5","doi-asserted-by":"publisher","first-page":"242","DOI":"10.4330\/wjc.v10.i11.242","article-title":"Surgical left atrial appendage occlusion during cardiac surgery: a systematic review and meta-analysis","volume":"10","author":"Atti","year":"2018","journal-title":"World J Cardiol"},{"key":"2026051515520527100_ezag146-B6","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1093\/ejcts\/ezu291","article-title":"Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis","volume":"47","author":"Tsai","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026051515520527100_ezag146-B7","doi-asserted-by":"publisher","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): developed by the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC), with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"2026051515520527100_ezag146-B8","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.1016\/j.jcin.2024.04.050","article-title":"Position statement on cardiac computed tomography following left atrial appendage occlusion","volume":"17","author":"Korsholm","year":"2024","journal-title":"JACC Cardiovasc Interv"},{"key":"2026051515520527100_ezag146-B9","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1016\/s0735-1097(00)00765-8","article-title":"Surgical left atrial appendage ligation is frequently incomplete: a transesophageal echocardiograhic study","volume":"36","author":"Katz","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2026051515520527100_ezag146-B10","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1016\/j.jacc.2008.03.067","article-title":"Success of surgical left atrial appendage closure. Assessment by transesophageal echocardiography","volume":"52","author":"Kanderian","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2026051515520527100_ezag146-B11","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1001\/jama.1949.02900440011003","article-title":"Resection of the left auricular appendix; a prophylaxis for recurrent arterial emboli","volume":"140","author":"Madden","year":"1949","journal-title":"J Am Med Assoc"},{"key":"2026051515520527100_ezag146-B12","doi-asserted-by":"publisher","first-page":"2283","DOI":"10.1016\/j.athoracsur.2011.08.044","article-title":"Left atrial appendage occlusion: lessons learned from surgical and transcatheter experiences","volume":"92","author":"Chatterjee","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2026051515520527100_ezag146-B13","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1093\/ehjci\/jeae236","article-title":"Reproducibility of cardiac computed tomography classifications of hypoattenuated thickening and peridevice leak following left atrial appendage closure","volume":"26","author":"Kramer","year":"2024","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026051515520527100_ezag146-B14","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1016\/j.jacc.2011.11.028","article-title":"The clinical impact of incomplete left atrial appendage closure with the watchman device in patients with atrial fibrillation: a PROTECT AF (percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation) substudy","volume":"59","author":"Viles-Gonzalez","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2026051515520527100_ezag146-B15","doi-asserted-by":"publisher","first-page":"3122","DOI":"10.1016\/j.jacc.2020.04.067","article-title":"Left atrial appendage closure versus direct oral anticoagulants in high-risk patients with atrial fibrillation","volume":"75","author":"Osmancik","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026051515520527100_ezag146-B16","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.jcin.2022.12.006","article-title":"Peridevice leak after left atrial appendage occlusion: incidence, mechanisms, clinical impact, and management","volume":"16","author":"Alkhouli","year":"2023","journal-title":"JACC Cardiovasc Interv"},{"key":"2026051515520527100_ezag146-B17","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1510\/icvts.2009.227991","article-title":"Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion?","volume":"10","author":"Dawson","year":"2010","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026051515520527100_ezag146-B18","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1016\/j.hrthm.2015.03.028","article-title":"Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization","volume":"12","author":"Aryana","year":"2015","journal-title":"Heart Rhythm"},{"key":"2026051515520527100_ezag146-B19","doi-asserted-by":"publisher","first-page":"184","DOI":"10.31083\/j.rcm2406184","article-title":"Different techniques of surgical left atrial appendage closure and their efficacy: a systematic review","volume":"24","author":"D\u2019Abramo","year":"2023","journal-title":"Rev Cardiovasc Med"},{"key":"2026051515520527100_ezag146-B20","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026051515520527100_ezag146-B21","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.jacc.2012.06.046","article-title":"Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation","volume":"62","author":"Bartus","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2026051515520527100_ezag146-B22","doi-asserted-by":"publisher","first-page":"191","DOI":"10.2459\/JCM.0000000000001446","article-title":"The role of cardiac imaging before and after left atrial appendage standalone thoracoscopic exclusion","volume":"24","author":"Mochen","year":"2023","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"2026051515520527100_ezag146-B23","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1016\/j.hrthm.2016.01.022","article-title":"Short and long-term outcomes of percutaneous left atrial appendage suture ligation: results from a US multicenter evaluation","volume":"13","author":"Lakkireddy","year":"2016","journal-title":"Heart Rhythm"},{"key":"2026051515520527100_ezag146-B24","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1016\/j.athoracsur.2023.09.010","article-title":"A comparative study of thoracoscopic left atrial appendage clipping vs stapled resection","volume":"117","author":"Lim","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2026051515520527100_ezag146-B25","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1016\/j.athoracsur.2024.02.012","article-title":"Incidence of acute thrombosis after surgical left atrial appendage occlusion for atrial fibrillation","volume":"117","author":"Inoue","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2026051515520527100_ezag146-B26","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1016\/j.hrthm.2018.05.026","article-title":"Thoracoscopic stapler-and-loop technique for left atrial appendage closure in nonvalvular atrial fibrillation: mid-term outcomes in 201 patients","volume":"15","author":"Ohtsuka","year":"2018","journal-title":"Heart Rhythm"},{"key":"2026051515520527100_ezag146-B27","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/s11748-023-01961-4","article-title":"A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke","volume":"72","author":"Yoshimoto","year":"2024","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"2026051515520527100_ezag146-B28","doi-asserted-by":"publisher","first-page":"1215EP","DOI":"10.1016\/j.hlc.2024.02.010","article-title":"Thoracoscopic left atrial appendage occlusion with the AtriClip PRO2: an experience of 144 patients","volume":"33","author":"Wang","year":"2024","journal-title":"Heart Lung and Circulation"},{"key":"2026051515520527100_ezag146-B29","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.hrthm.2019.08.003","article-title":"Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation: long-term results of a multicenter study","volume":"17","author":"Mohanty","year":"2020","journal-title":"Heart Rhythm"},{"key":"2026051515520527100_ezag146-B30","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.jacep.2015.08.005","article-title":"Left atrial appendage ligation in nonvalvular atrial fibrillation patients at high risk for embolic events with ineligibility for oral anticoagulation initial report of clinical outcomes","volume":"1","author":"Sievert","year":"2015","journal-title":"JACC: Clinical Electrophysiology"},{"key":"2026051515520527100_ezag146-B31","doi-asserted-by":"publisher","first-page":"E901","DOI":"10.1532\/hsf.3511","article-title":"A comparative study between different surgical techniques for left atrial exclusion in patients undergoing concomitant cardiac surgery","volume":"24","author":"Abdeljawad","year":"2021","journal-title":"Heart Surg Forum"},{"key":"2026051515520527100_ezag146-B32","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1016\/j.jcin.2016.01.038","article-title":"Clinical implications of leaks following left atrial appendage ligation with the LARIAT device","volume":"9","author":"Gianni","year":"2016","journal-title":"JACC: Cardiovascular Interventions"},{"key":"2026051515520527100_ezag146-B33","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1016\/j.jacep.2017.03.008","article-title":"Angiographic efficacy of the Atriclip left atrial appendage exclusion device placed by minimally invasive thoracoscopic approach","volume":"3","author":"Ellis","year":"2017","journal-title":"JACC: Clinical Electrophysiology"},{"key":"2026051515520527100_ezag146-B34","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1016\/j.jtcvs.2011.07.052","article-title":"Exclusion of the left atrial appendage with a novel device: early results of a multicenter trial","volume":"142","author":"Ailawadi","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026051515520527100_ezag146-B35","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1177\/15569845221091998","article-title":"Left atrial appendage ligation using the AtriClip device: single-center study of device safety and efficacy","volume":"17","author":"Kiankhooy","year":"2022","journal-title":"Innovations (Phila)"},{"key":"2026051515520527100_ezag146-B36","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1016\/j.ahj.2004.09.054","article-title":"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","volume":"150","author":"Healey","year":"2005","journal-title":"Am Heart J"},{"key":"2026051515520527100_ezag146-B37","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1093\/icvts\/ivx427","article-title":"Residual echocardiographic and computed tomography findings after thoracoscopic occlusion of the left atrial appendage using the AtriClip PRO device","volume":"26","author":"Osmancik","year":"2018","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026051515520527100_ezag146-B38","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.ahj.2025.04.015","article-title":"Rationale and design of the anticoagulant therapy after left atrial appendage closure (ATLAAC) trial","volume":"287","author":"Gosvig","year":"2025","journal-title":"Am Heart J"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezag146\/67993149\/ezag146.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/5\/ezag146\/67993149\/ezag146.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/5\/ezag146\/67993149\/ezag146.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T19:52:13Z","timestamp":1778874733000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezag146\/8644325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezag146","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,8]]},"article-number":"ezag146"}}