{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:51:26Z","timestamp":1781650286774,"version":"3.54.5"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":45,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Concomitant left atrial appendage exclusion is increasingly performed during cardiac surgery in patients with atrial fibrillation. However, real-world data on procedural variations, closure integrity, and early safety are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 86 patients with atrial fibrillation who underwent concomitant left atrial appendage exclusion during cardiac surgery at a single center between 2012 and 2025. Nineteen patients underwent left atrial appendage occlusion using suture-based techniques or a closure device, and 67 underwent left atrial appendage resection with closure using sutures or a stapler. Residual flow was assessed using intraoperative transesophageal echocardiography, and outcomes were evaluated during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients in the occlusion group more often had longer atrial fibrillation duration, vitamin K antagonist use, and previous cardiac surgery. Mitral valve procedures were more frequently combined with occlusion, whereas maze ablation was more common in the resection group. Intraoperative residual flow was detected in three patients (16%) after occlusion and in none after resection. Both approaches showed favorable early safety, with no 30-day mortality and low reoperation rates due to bleeding. Differences in sinus rhythm and anticoagulation at three months were observed, but were likely influenced by concomitant maze procedures. Differences in long-term survival were also observed but should be interpreted cautiously because of baseline imbalances and unequal follow-up duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single-center retrospective case series, suture-based occlusion was associated with residual flow in a subset of patients, whereas no residual flow was detected after resection using intraoperative echocardiography. Both approaches showed acceptable early safety. Larger multicenter studies with standardized follow-up imaging are needed to clarify closure durability and the long-term clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13019-026-04017-9","type":"journal-article","created":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T12:45:46Z","timestamp":1775997946000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concomitant left atrial appendage exclusion during cardiac surgery: a single-center case series on technique profile, residual flow, and early safety"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7642-6020","authenticated-orcid":false,"given":"Masafumi","family":"Kudo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Tsubota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Akaguma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Honda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Okabayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"4017_CR1","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1056\/NEJMoa2101897","volume":"384","author":"RP Whitlock","year":"2021","unstructured":"Whitlock RP, Belley-Cote EP, Paparella D, Healey JS, Brady K, Sharma M, et al. Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N Engl J Med. 2021;384:2081\u201391.","journal-title":"N Engl J Med"},{"key":"4017_CR2","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/s11748-023-01961-4","volume":"72","author":"A Yoshimoto","year":"2024","unstructured":"Yoshimoto A, Suematsu Y, Kurahashi K, Takahashi H, Inoue T. A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke. Gen Thorac Cardiovasc Surg. 2024;72:157\u201363.","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"4017_CR3","doi-asserted-by":"publisher","first-page":"185","DOI":"10.5761\/atcs.oa.20-00204","volume":"27","author":"A Yoshimoto","year":"2021","unstructured":"Yoshimoto A, Suematsu Y, Kurahashi K, Kaneko H, Arima D, Nishi S. Early and Middle-Term Results and Anticoagulation Strategy after Left Atrial Appendage Exclusion Using an Epicardial Clip Device. Ann Thorac Cardiovasc Surg. 2021;27:185\u201390.","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"4017_CR4","doi-asserted-by":"crossref","first-page":"2914","DOI":"10.1093\/eurheartj\/ehae521","volume":"45","author":"U Landmesser","year":"2024","unstructured":"Landmesser U, Skurk C, Tzikas A, Falk V, Reddy VY, Windecker S. Left atrial appendage closure for stroke prevention in atrial fibrillation: current status and perspectives. Eur Heart J. 2024;45:2914\u201332.","journal-title":"Eur Heart J"},{"key":"4017_CR5","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1161\/CIRCULATIONAHA.121.055825","volume":"144","author":"S Verma","year":"2021","unstructured":"Verma S, Bhatt DL, Tseng EE. Time to Remove the Left Atrial Appendage at Surgery: LAAOS III in Perspective. Circulation. 2021;144:1088\u201390.","journal-title":"Circulation"},{"key":"4017_CR6","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13019-018-0740-7","volume":"13","author":"J Park-Hansen","year":"2018","unstructured":"Park-Hansen J, Holme SJV, Irmukhamedov A, Carranza CL, Greve AM, Al-Farra G, et al. Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study. J Cardiothorac Surg. 2018;13:53.","journal-title":"J Cardiothorac Surg"},{"key":"4017_CR7","doi-asserted-by":"publisher","first-page":"2283","DOI":"10.1016\/j.athoracsur.2011.08.044","volume":"92","author":"S Chatterjee","year":"2011","unstructured":"Chatterjee S, Alexander JC, Pearson PJ, Feldman T. Left atrial appendage occlusion: lessons learned from surgical and transcatheter experiences. Ann Thorac Surg. 2011;92:2283\u201392.","journal-title":"Ann Thorac Surg"},{"key":"4017_CR8","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.xjtc.2024.05.007","volume":"26","author":"J Petersen","year":"2024","unstructured":"Petersen J, B\u00f6ning H, Yildirim S, Alassar Y, Yildirim Y, Bazhanov I, et al. Efficacy of four different left atrial appendage closure techniques during cardiac surgery-A transesophageal echocardiography follow-up study. JTCVS Tech. 2024;26:43\u20139.","journal-title":"JTCVS Tech"},{"key":"4017_CR9","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s12872-025-04540-y","volume":"25","author":"C Huang","year":"2025","unstructured":"Huang C, Huang J, Shen S, Li Y, Zhang Y, Zhang X, et al. The efficiency of endocardial suture occlusion of the left atrial appendage at a single institution: MICs vs. sternotomy. BMC Cardiovasc Disord. 2025;25:128.","journal-title":"BMC Cardiovasc Disord"},{"key":"4017_CR10","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1016\/j.jacc.2008.03.067","volume":"52","author":"AS Kanderian","year":"2008","unstructured":"Kanderian AS, Gillinov AM, Pettersson GB, Blackstone E, Klein AL. Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol. 2008;52:924\u20139.","journal-title":"J Am Coll Cardiol"},{"key":"4017_CR11","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1093\/eurheartj\/ehab593","volume":"43","author":"S Willems","year":"2022","unstructured":"Willems S, Borof K, Brandes A, Breithardt G, Camm AJ, Crijns H, et al. Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial. Eur Heart J. 2022;43:1219\u201330.","journal-title":"Eur Heart J"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-026-04017-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-026-04017-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-026-04017-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:52:11Z","timestamp":1781646731000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13019-026-04017-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,12]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4017"],"URL":"https:\/\/doi.org\/10.1186\/s13019-026-04017-9","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,12]]},"assertion":[{"value":"3 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Institutional Ethics Committee of Mitsubishi Kyoto Hospital (Approval Number: 25\u2009\u2212\u20095). Given the retrospective design, individual informed consent was waived. No identifiable patient information is included in this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"265"}}