Perioperative Results from Left Atrial Appendage Removal during Open Heart Surgery

Purpose: The value of coronary angiography in the diagnosis of thrombus in the left atrial appendage (LAA) was retrospectively analyzed. Material and Methods: The study covers 34 patients in whom coronary angiography showed coronary neovascularity in LAA with coronary artery-left atrial fistula indicating LAA thrombus. All 34 patients underwent transthoracic echocardiography within one week of coronary angiography. Open-heart surgery was undertaken 2–31 months after angiography in 28 patients. Results: Coronary neovascularity and coronary artery-left atrial fistula arose from the left circumflex artery in 28 patients, and from the left circumflex artery and the right coronary artery in the remaining 6 patients. By echocardiography, LAA thrombus was detected in only one of the 34 patients. In 18 of the 28 patients who underwent open-heart surgery, LAA thrombus was found at surgery to have resolved. Conclusion: Coronary angiography is useful in the diagnosis of LAA thrombus, and coronary neovascularity and fistula formation may indicate that the thrombus can spontaneously resolve.

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Abstract 4291: Left Atrial Appendage Occlusion: Early Clinical Results with a New Clip

Circulation ◽

10.1161/circ.118.suppl_18.s_860 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Sacha P Salzberg ◽

Andre Plass ◽

Hatem Alkadhi ◽

Jurg Grunenfelder ◽

Rolf Jenny ◽

...

Keyword(s):

Left Atrial ◽

Heart Surgery ◽

Left Atrial Appendage ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Significant Risk ◽

Significant Risk Factor ◽

Clinical Results ◽

Atrial Appendage

Background: Atrial fibrillation (AF) is a common arrhythmia and as such a significant risk factor for stroke originating from the left atrial appendage (LAA). The purpose of this study is to evaluate surgical LAA occlusion with a new clip in patients with AF undergoing open heart surgery (OHS) at 3 month follow-up with cardiac multidetector computed tomography (MDCT). Patients and Methods: From 9/2007 to 5/2008, patients undergoing OHS with AF were enrolled in a trial for concomitant clip placement (LAA clip, Atricure Inc., Westchester, Ohio (USA)). The LAA clip is composed of titanium rods with nitinol hinges, surrounded by polyester braiding, applied epicardially on the LAA. LAA geometry and perfusion was assessed by trans-esophageal echocardiography (TEE). Postoperative and 3 month follow-up MDCT was compared to preoperative data to assess Clip location, LAA perfusion and cardiac anatomy. Results: 30 patients underwent LAA Clip placement through a median sternotomy. Clip deployment was successful in all (n=30), no device related complications occurred. LAA measurement and clip placement took less than 30 seconds and one attempt. After deployment TEE confirmed absence of LAA perfusion in all. Operative mortality was 6% (n=2) and was unrelated to clip placement. Pre-discharge (n=28) and 3 month follow-up (n=18) MDCT demonstrated stable clip location, absent LAA perfusion and normal surrounding cardiac structures. Conclusion: LAA Clip occlusionis safe, easy and straightforward. LAA occlusion remains effective and durable, per TEE and MDCT. When applied in a minimally invasive fashion LAA clip occlusion might offer a valuable tool for stroke prevention in selected patients.

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