This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan View Related CVN News Brief Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Kanderian, A. S. Articles by Klein, A. L. Search for Related Content PubMed Articles by Kanderian, A. S. Articles by Klein, A. L. Related Collections Related Articles

CLINICAL RESEARCH: CARDIAC SURGERY

Success of Surgical Left Atrial Appendage Closure

Assessment by Transesophageal Echocardiography

Anne S. Kanderian, MD^_*, A. Marc Gillinov, MD, Gosta B. Pettersson, MD, PhD, Eugene Blackstone, MD and Allan L. Klein, MD, FACC^_*,_*

^_* Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio

Manuscript received November 27, 2007; revised manuscript received February 26, 2008, accepted March 11, 2008.

^_* Reprint requests and correspondence: Dr. Allan L. Klein, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk F15, Cleveland, Ohio 44195 (Email: kleina{at}ccf.org).

Objectives: We sought to determine which surgical technique of left atrial appendage (LAA) closure is most successful by assessing them with transesophageal echocardiography (TEE).

Background: Atrial fibrillation is a risk factor for stroke, with 90% of clots occurring in the LAA. Several surgical techniques of LAA closure are used to theoretically reduce the stroke risk, with varying success rates.

Methods: A total of 137 of 2,546 patients who underwent surgical LAA closure from 1993 to 2004 had a TEE after surgery. Techniques consisted of either excision or exclusion by sutures or stapling. The TEE measurements included color Doppler flow in the LAA and interrogation for thrombus. Patent LAA, remnant LAA (residual stump >1 cm), or excluded LAA with persistent flow into the LAA were identified as unsuccessful closure.

Results: Of the 137 patients, 52 (38%) underwent excision and 85 (62%) underwent exclusion (73 suture and 12 stapler). Only 55 of 137 (40%) of closures were successful. Successful LAA closure occurred more often with excision (73%) than suture exclusion (23%) and stapler exclusion (0%) (p < 0.001). We found LAA thrombus to be present in 28 of 68 patients (41%) with unsuccessful LAA exclusion versus none with excision. At time of TEE, 6 patients with successful LAA closure (11%) and 12 with unsuccessful closure (15%) had evidence of stroke/transient ischemic attack (p = 0.61).

Conclusions: There is a high occurrence of unsuccessful surgical LAA closure. Of the various techniques, excision appears to be the most successful.

Key Words: atrial fibrillation • left atrial appendage • surgical left atrial appendage closure • left atrial appendage thrombus • stroke

Abbreviations and Acronyms   AF = atrial fibrillation   ANP = atrial natriuretic peptide   LAA = left atrial appendage   TEE = transesophageal echocardiography   TIA = transient ischemic attack

Related Articles

What Is the Best Way to Surgically Eliminate the Left Atrial Appendage?

Ralph J. Damiano, Jr
J. Am. Coll. Cardiol. 2008 52: 930-931. [Full Text] [PDF]

This article has been cited by other articles:

				S. C. Stamou, K. R. Khabbaz, F. Mahmood, P. Zimetbaum, and R. C. Hagberg A Multidisciplinary Approach to the Minimally Invasive Pulmonary Vein Isolation for Treatment of Atrial Fibrillation. Ann. Thorac. Surg., February 1, 2010; 89(2): 648 - 650. [Abstract] [Full Text] [PDF]

				A. G. Dawson, S. Asopa, and J. Dunning Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion? Interactive CardioVascular and Thoracic Surgery, February 1, 2010; 10(2): 306 - 311. [Abstract] [Full Text] [PDF]

				K. Stergiopoulos, F. Seifert, and D. L. Brown Thrombus Formation After Successful Stapler Exclusion of the Left Atrial Appendage J. Am. Coll. Cardiol., January 26, 2010; 55(4): 379 - 379. [Full Text] [PDF]

				R. P. Whitlock, J. S. Healey, and S. J. Connolly Left Atrial Appendage Occlusion Does Not Eliminate the Need for Warfarin Circulation, November 10, 2009; 120(19): 1927 - 1932. [Full Text] [PDF]

				A. D. Nagpal, L. Torracca, A. Fumero, P. Denti, M. Cioni, and O. Alfieri Concurrent prophylactic left atrial appendage exclusion: results from a randomized controlled trial pilot study Eur. J. Cardiothorac. Surg., September 1, 2009; 36(3): 553 - 557. [Abstract] [Full Text] [PDF]

				D. H. Adams, A. C. Anyanwu, J. Chikwe, and F. Filsoufi The Year in Cardiovascular Surgery J. Am. Coll. Cardiol., June 23, 2009; 53(25): 2389 - 2403. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al. Highlights of the Year in JACC 2008. J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398. [Full Text] [PDF]

				R. J. Damiano Jr What Is the Best Way to Surgically Eliminate the Left Atrial Appendage? J. Am. Coll. Cardiol., September 9, 2008; 52(11): 930 - 931. [Full Text] [PDF]