Echocardiographic Evaluation of Different LAA Closure Techniques during Concomitant Surgical AF Ablation

Objectives: Left atrial appendage (LAA) closure is a routine part of AF ablation surgery. Different LAA closure techniques are used in cardiac surgery with various results. We therefore evaluated efficacy of four different LAA closure methods in patients after concomitant surgical AF ablation using transesophageal echocardiography.

Methods: A total of 74 patients that underwent surgical AF ablation with LAA closure between 05/2015 and 12/2017 were included in the transesophageal echocardiography study. Four different LAA closure approaches were evaluated: (1) LAA clipping using Atriclip, LAA suture ligation, LAA resection using a stapler, and LAA excision followed by suturing of the LAA base. Successful LAA closure was defined as absence of LAA reperfusion and absence of a stump of more than 10 mm.

Result: Mean patients age was 68.4 ± 9.1 years, 62.8% were male. No LAA closure related complications were observed. Mean follow-up duration was 36.5 months. 2 patients (2.6%), one with and one without successful LAA closure experienced a stroke during follow-up. Atriclip was used in 17 patients and resulted in successful LAA closure in all patients (100%). LAA resection using stapler resulted in 73% of successful LAA closure (16/22 patients). Unsuccessful closure was seen in 6 patients with a remaining stump of more than 10 mm. LAA excision followed by suturing was successful in 92% (12/13 patients), with one failure of complete closure due to residual stump > 10 mm. LAA Suture ligation resulted in a low rate of successful LAA closure of only 36% (8/22 patients). 14 patients had a reperfusion of the LAA or a stump >10 mm during follow-up.

Conclusion: In our study, LAA clipping and LAA excision followed by suturing of the LAA base were both successful LAA closure methods. External LAA ligation resulted in a very low rate of successful LAA closure, and should thus be avoided

Publication History

Article published online:
19 February 2021