{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:10:53Z","timestamp":1788757853758,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atrial fibrillation is a leading cause of cardioembolic stroke, and the left atrial appendage (LAA) is the principal source of thrombus formation in non\u2010valvular disease. Surgical LAA exclusion is commonly performed during cardiac surgery, but incomplete closure resulting in a residual communication is not uncommon and may carry ongoing thromboembolic risk. Unlike peri\u2010device leaks after transcatheter closure, residual surgical leaks are anatomically and mechanistically distinct, typically arising through a central, fibrotic ostium with a variable residual pouch, and no validated management pathway currently exists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a structured literature search of PubMed\/MEDLINE, Embase, the Cochrane Library, and Google Scholar for reported cases and surgical subgroups in which residual leaks after surgical LAA ligation or amputation were managed percutaneously. Because the evidence was predominantly observational and case\u2010based, findings were synthesized narratively rather than as a formal meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 37 reported percutaneous procedures identified from case reports, small series, and registry surgical subgroups, closure strategies comprised vascular plugs and septal occluders, dedicated LAA occlusion devices, non\u2010barbed disc\u2010based occluders in anatomically high\u2010risk cases, and endocardial radiofrequency ablation for uncrossable fibrotic leaks. Acute success was high, although outcome reporting was heterogeneous and long\u2010term data were limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Residual surgical LAA leaks are an underrecognized, anatomically distinct entity. We propose an anatomy\u2010tailored management framework integrating leak traversability, adjacent vascular anatomy, ostial morphology, and residual pouch depth; given the limited evidence, this should be regarded as hypothesis\u2010generating, and prospective multicenter data are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70424","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:21:00Z","timestamp":1788754860000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Residual Surgical Left Atrial Appendage Leaks: Thromboembolic Risk and Anatomy\u2010Tailored Percutaneous Closure Strategies"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5232-8436","authenticated-orcid":false,"given":"Ahmet","family":"K\u0131vrak","sequence":"first","affiliation":[{"name":"Department of Cardiology Hacettepe University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2965-058X","authenticated-orcid":false,"given":"Mert","family":"Dogan","sequence":"additional","affiliation":[{"name":"Kozluk State Hospital  Batman Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5520-7103","authenticated-orcid":false,"given":"Cem","family":"Coteli","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hacettepe University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3332-9112","authenticated-orcid":false,"given":"Ahmet Haydar","family":"Keresteci","sequence":"additional","affiliation":[{"name":"Department of Cardiology Sincan Training and Research Hospital  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet Hakan","family":"Ates","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hacettepe University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4250-1706","authenticated-orcid":false,"given":"U\u011fur","family":"Canpolat","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hacettepe University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7673-229X","authenticated-orcid":false,"given":"Hikmet","family":"Yorgun","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hacettepe University Faculty of Medicine  Ankara Turkey"},{"name":"Department of Cardiology Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Medical Center  Limburg The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Levent","family":"Sahiner","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hacettepe University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4424-3704","authenticated-orcid":false,"given":"Ergun Baris","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hacettepe University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kudret","family":"Aytemir","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hacettepe University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2017.12.008"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.976449"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezu291"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.03.067"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.03.001"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.03.028"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2021.06.018"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30139"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.08.034"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2101897"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735\u20101097(00)00765\u20108"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2017.02.17"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.09.054"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2013.06.015"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840\u2010023\u201001729\u2010z"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.12.006"},{"issue":"8","key":"e_1_2_10_18_1","article-title":"Cardiac CT versus Transesophageal Echocardiography Following Left Atrial Appendage Closure: A Systematic Review and Meta\u2010Analysis","volume":"18","author":"Tan B. E.\u2010X.","year":"2025","journal-title":"Circulation: Cardiovascular Imaging"},{"issue":"11","key":"e_1_2_10_19_1","article-title":"Percutaneous Left Atrial Appendage Closure: Current Devices and Clinical Outcomes","volume":"10","author":"Asmarats L.","year":"2017","journal-title":"Circulation: cardiovascular interventions"},{"issue":"1","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1186\/s12872-026-05689-w","article-title":"Percutaneous Closure of Residual Leak After Surgical Left Atrial Appendage Ligation: A Case of Stroke Prevention in High\u2010risk Atrial Fibrillation","volume":"26","author":"Do\u011fan M.","year":"2026","journal-title":"BMC Cardiovascular Disorders"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840\u2010025\u201002090\u2010z"},{"issue":"5","key":"e_1_2_10_22_1","first-page":"333","article-title":"Transcatheter Closure of a Post\u2010Surgical Left Atrial Appendage Ligation Leak Using a Patent Foramen Ovale Occluder","volume":"30","author":"Do\u011fan M.","year":"2026","journal-title":"Anatolian Journal of Cardiology"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2025.10.024"},{"issue":"3","key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jcin.2019.10.022","article-title":"First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure","volume":"13","author":"Horton R. P.","year":"2020","journal-title":"JACC Cardiovasc Interv"},{"issue":"10","key":"e_1_2_10_25_1","article-title":"Use of a Novel Septal Occluder Device for Left Atrial Appendage Closure in Patients With Postsurgical and Postlariat Leaks or Anatomies Unsuitable for Conventional Percutaneous Occlusion","volume":"13","author":"Della Rocca D. 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