{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:11:10Z","timestamp":1778735470359,"version":"3.51.4"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The presence of a left atrial appendage (LAA) thrombus is traditionally considered a contraindication to epicardial left atrial appendage closure (LAAC) because of the risk of periprocedural embolization. This presents a significant challenge for atrial fibrillation (AF) patients with a high bleeding risk who are intolerant to long-term anticoagulant treatment. The safety and outcomes of epicardial LAAC in patients with a preexisting LAA thrombus remain poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included 108 AF patients who underwent epicardial LAAC at a single center. Patients were stratified into two groups on the basis of preoperative imaging: the Thrombus Group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911) and the No-Thrombus Group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200997). Intraoperative management, perioperative complications, and long-term clinical outcomes (cerebrovascular events and all-cause mortality) were compared between the groups. An imaging-based classification of thrombus morphology (Types I-III) was proposed for risk stratification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No intraoperative strokes or deaths occurred in either group. Early postoperative complication rates were low and not significantly different between groups. During follow-up, the rates of thromboembolic events (1.0 vs. 2.3 per 100 patient-years) and all-cause mortality (0.3 vs. 0.0 per 100 patient-years) were comparable between the No-Thrombus and Thrombus groups, with no statistically significant differences. Thrombi confined to the LAA tip (Type I) were associated with favorable outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Epicardial LAAC appears to be a feasible and safe alternative for stroke prevention in some AF patients with LAA thrombi who are unsuitable for anticoagulation therapy, as it does not increase perioperative risk or compromise long-term treatment efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1779256","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:32:13Z","timestamp":1778733133000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of preoperative left atrial appendage thrombus on surgical outcomes in atrial fibrillation patients undergoing epicardial left atrial appendage closure"],"prefix":"10.3389","volume":"13","author":[{"given":"Qing","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Beijing Tiantan Hospital, Capital Medical 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