Left Atrial Appendage Exclusion for Stroke Prevention in Atrial Fibrillation: Surgical, Percutaneous, and Hybrid Approaches

Atrial fibrillation (AF) is becoming more common as populations age and more patients live with multiple conditions. AF remains a major cause of cardioembolic stroke and a frequent finding in patients referred for cardiac surgery. Oral anticoagulation is still central to stroke prevention, but in surgical populations it is often complicated by frailty, prior bleeding, renal dysfunction, adherence challenges, and peri-operative risk. In this context, management of the left atrial appendage (LAA) – including concomitant and prophylactic LAA exclusion during open-heart surgery – is increasingly considered as part of an overall strategy to reduce thromboembolic events.This Research Topic will focus on cardiovascular surgery perspectives on AF-related stroke prevention, while also covering the roles of percutaneous LAA occlusion (LAAO), imaging, and antithrombotic management. We welcome clinical, translational, and health-services research that informs patient selection, procedural technique, durability of closure, follow-up imaging, post-procedural treatment pathways, and longer-term outcomes – especially in real-world cardiac surgical populations.Submissions may include, but are not limited to, the following themes (or closely related topics):1. Concomitant and prophylactic LAA exclusion during cardiac surgery• Indications, patient selection, and intraoperative decision-making• Techniques and comparative performance (e.g., excision, suture/ligation, epicardial devices/clips)• Durability of closure and clinical implications of incomplete LAA exclusion2. Surgical AF strategies integrated with stroke prevention• Combined surgical ablation and LAA exclusion approaches• Outcomes when LAA exclusion is performed alongside valve surgery, CABG, and other procedures• Post-operative rhythm status, anticoagulation strategies, and follow-up pathways3. Hybrid and multidisciplinary approaches• Hybrid (surgical + percutaneous) strategies for complex anatomy or prior failed interventions• Heart-team models linking cardiac surgery, electrophysiology, and structural heart programs• Referral pathways and sequencing across the AF treatment pathway4. Imaging and procedural assessment• Pre- and intraoperative imaging to guide LAA strategy (TEE/CT)• Post-operative imaging and criteria for defining successful exclusion/occlusion• Standardized reporting and clinically meaningful endpoints5. Antithrombotic management and net clinical benefit• Peri-operative and long-term antithrombotic strategies after surgical LAA exclusion• Balancing stroke prevention with bleeding risk in surgical patients• Pragmatic protocols and real-world outcomes6. Comparative evidence: surgical LAA exclusion vs. percutaneous LAAO and medical therapy• Comparative effectiveness and safety across patient subgroups• Complications, reintervention rates, and long-term stroke/bleeding outcomes• Cost-effectiveness and health-system impact7. Special populations relevant to cardiac surgery• Elderly/frail patients and those with high bleeding risk• Valvular AF and complex structural heart disease• Heart failure/cardiomyopathies and patients undergoing repeat surgeryBy focusing on surgical decision-making, technical durability, and post-operative pathways for LAA management during open-heart surgery, this Research Topic aims to clarify how prophylactic and concomitant LAA exclusion can be integrated into AF stroke-prevention strategies to improve patient outcomes. Topic editors: Basel Ramlawi, Giovanni Mariscalco Source: https://www.frontiersin.org/research-topics/81147/left-atrial-appendage-exclusion-for-stroke-prevention-in-atrial-fibrillation-surgical-percutaneous-and-hybrid-approaches