Skip to main content

Advertisement

SpringerLink
Log in

Exclusion of the left atrial appendage: an effective method

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

The left atrial appendage (LAA) is a frequent site of thrombus formation in patients with mitral valve disease, especially in those with atrial fibrillation (AF). Several surgical techniques of LAA closure are used with varying success rates. An incomplete LAA closure becomes a nidus for thrombus formation and is a potential source of embolization. To combat this difficulty we used a novel technique to effectively and completely exclude the LAA during mitral valve surgery.

Methods

Twenty-eight patients with mitral valve disease and in AF with or without a left atrium (LA)/LAA clot were enrolled in this prospective study. We used fresh autologous pericardial patch to occlude the LAA orifice. All the patients were reviewed at 3 months for any history of thromboembolic events, and a transoesophageal echocardiography (TEE) was also done to look for the completeness of repair.

Results

All the patients had an uneventful recovery. Our technique resulted in complete exclusion of the LAA from LA, which was confirmed by TEE at 3 months post-operatively and showed no residual connection between the LA and LAA, no fresh LA clot, and a good valve function as well. There was no history of any thromboembolic phenomena in any patient.

Conclusion

In patients with mitral valve disease in AF with/without the presence of LA/LAA clot, using an autologous pericardial patch to exclude the LAA is a relatively simple procedure and results in complete exclusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Katz ES, Tsiamtsiouris T, Applebaum RM, Schwartzbard A, Tunick PA, Kronzon I. Surgical left atrial appendage ligation is frequently incomplete: a transesophageal echocardiographic study. J Am Coll Cardiol. 2000;36:468–71.

  2. Wood P. Diseases of the heart and circulation. Philadelphia: J. B. Lippincott Company; 1968. p. 625.

  3. Selzer A, Katayama F. Mitral regurgitation: clinical patterns, pathophysiology and natural history. Medicine. 1972;51:337–66.

  4. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61:755–9.

    Article  CAS  PubMed  Google Scholar 

  5. January CT, Wann L, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:2246–80.

  6. Sakellaridis T, Argiriou M, Charitos C, et al. Left atrial appendage exclusion—where do we stand? J Thorac Dis. 2014;6:s70–7.

  7. Dawson AG, Asopa S, Dunning J. Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion? Interact Cardiovasc Thorac Surg. 2010;10:306–11.

    Article  PubMed  Google Scholar 

  8. Johnson WD, Ganjoo AK, Stone CD, Srivyas RC, Howard M. The left atrial appendage: our most lethal human attachment! Surgical implications. Eur J Cardiotoracic Surg. 2000;17:718–22.

  9. Leung DY, Black IW, Cranney GB, Hopkins AP, Walsh WF. Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation. J Am Coll Cardiol. 1994;24:755–62.

  10. Hellerstein HK, Sinaiko E, Dolgin M. Amputation of the canine atrial appendages. Proc Soc Exp Biol Med. 1947;66:337.

    Article  CAS  PubMed  Google Scholar 

  11. Madden JL. Resection of the left auricular appendix—a prophylaxis for recurrent arterial emboli. JAMA. 1949;140:769–72.

    Article  CAS  Google Scholar 

  12. Kanderian AS, Gillinov AM, Pettersson GB, Blackstone E, Klein AL. Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol. 2008;52:924–9.

  13. Garcia-Fernandez MA, Perez-David E, Quiles J, et al. Role of left atrial appendage obliteration in stroke reduction in patients with mitral valve prosthesis: a transesophageal echocardiographic study. J Am Coll Cardiol. 2003;42:1253–8.

    Article  PubMed  Google Scholar 

  14. Emmerta MY, Puippeb G, Baumüllerb S, et al. Safe, effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery: first long-term results from a prospective device trial. EJCTS. 2014;45:126–31.

    Google Scholar 

  15. Bartus K, Han FT, Bednarek J, et al. Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: initial clinical experience. J Am Coll Cardiol. 2013;62:108–18.

  16. Ostermayer SH, Reisman M, Kramer PH, et al. Percutaneous left atrial appendage transcatheterocclusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multicenter feasibility trials. J Am Coll Cardiol. 2005;46:9–14.

    Article  PubMed  Google Scholar 

  17. Fountain RB, Holmes DR, Chandrasekaran K, et al. The PROTECT AF (WATCHMAN left atrial appendage system for embolic PROTECTion in patients with atrial fibrillation) trial. Am Heart J. 2006;151:956–61.

  18. Sick PB, Ulrich M, Hauptmann KE, et al. Stroke prevention technology for patients with non-valvular AF—worldwide experience with the new watchman LAA system. J Am Coll Cardiol. 2006;47:36A.

    Article  Google Scholar 

Download references

Acknowledgements

No funding/grants, financial support, technical, or any other assistance was required in this study.

Author information

Authors and Affiliations

  1. Department of Cardio Thoracic & Vascular Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, 226003, India

    Sushil Kumar Singh, Prabhdeep Singh Sudan, Vivek Tewarson, Sarvesh Kumar & Bhupendra Kumar

  2. Department of Anesthesia, King George’s Medical University, Lucknow, Uttar Pradesh, 226003, India

    Brij Bihari Kushwaha

  3. Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, 226003, India

    Sharad Chandra

Authors
  1. Sushil Kumar Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prabhdeep Singh Sudan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vivek Tewarson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brij Bihari Kushwaha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sharad Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarvesh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bhupendra Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sushil Kumar Singh.

Ethics declarations

There has been no source of funding, no conflicts and/or competing interests, and no previous publication or presentation of any kind involving this study. This study is in compliance with the requirements of the institutional ethics committee. Informed consent was obtained from all participants of the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study was not funded by any agency or body.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institution.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, S.K., Sudan, P.S., Tewarson, V. et al. Exclusion of the left atrial appendage: an effective method. Indian J Thorac Cardiovasc Surg 33, 110–116 (2017). https://doi.org/10.1007/s12055-017-0495-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-017-0495-0

Keywords

Search

Navigation