Complete obliteration of the left atrial appendage an analysis of epicardial excision and novel pericardial patch exclusion

Bayan B. Malakouti-Nejad, Eliot J. Winkler, Marjorie I. Johnson, Jorge Catrip, Katie L. Losenno, Bob B. Kiaii, Michael W.A. Chu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objective: Conventional epicardial excision is believed to be the most effective method of surgically obliterating the left atrial appendage (LAA), although incomplete resection and residual LAA volume may undermine its effectiveness. We sought to compare the impact of conventional epicardial excision with a novel LAA pericardial patch exclusion on residual LAA volume. Methods: We performed LAA obliteration using pericardial patch exclusion, followed by conventional epicardial excision, in 27 cadaveric hearts. After each procedure, residual LAA volume was measured by two different techniques and compared with baseline volume. There was no difference in baseline LAA volume between each procedure. Results: Procedural success was achieved in all hearts. Conventional epicardial excision left a residual LAA volume of 0.95 mL (24%), as compared with pericardial patch exclusion, which left a residual volume of 0.17 mL (4%, P = 0.0001). Further analysis of fixed and fresh hearts showed that reduction of LAA volume was more pronounced in the fresh hearts, suggesting effectiveness in live patients. Neither technique resulted in any significant change in the endocardial shape of the LAA orifice or injury to the circumflex artery. Conclusions: Conventional epicardial excision of the LAA results in significantly more residual LAAvolume, which may have important implications in persistent stroke risk. Pericardial patch exclusion seems to achieve near-total elimination of the LAA and may be a superior surgical option.

Original languageEnglish (US)
Pages (from-to)282-287
Number of pages6
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume11
Issue number4
DOIs
StatePublished - 2016
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Epicardial excision
  • LAA closure
  • Left atrial appendage
  • Pericardial patch exclusion

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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