Efficacy of four different left atrial appendage closure techniques during cardiac surgery—A transesophageal echocardiography follow-up studyCentral MessagePerspective
Objective: Closure of the left atrial appendage (LAA) is a routine part of atrial fibrillation ablation surgery and significantly reduces stroke rates. Different LAA-closure techniques are used in cardiac surgery with variable results reported. We therefore evaluated the efficacy of 4 different LAA-...
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| Language: | English |
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Elsevier
2024-08-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724002281 |
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| author | Johannes Petersen, MD Henrike Böning, MD Sevenai Yildirim, MD Yousuf Alassar, MD Yalin Yildirim, MD Ilia Bazhanov, MD Christoph Sinning, MD Hermann Reichenspurner, MD, PhD Simon Pecha, MD |
| author_facet | Johannes Petersen, MD Henrike Böning, MD Sevenai Yildirim, MD Yousuf Alassar, MD Yalin Yildirim, MD Ilia Bazhanov, MD Christoph Sinning, MD Hermann Reichenspurner, MD, PhD Simon Pecha, MD |
| author_sort | Johannes Petersen, MD |
| collection | DOAJ |
| description | Objective: Closure of the left atrial appendage (LAA) is a routine part of atrial fibrillation ablation surgery and significantly reduces stroke rates. Different LAA-closure techniques are used in cardiac surgery with variable results reported. We therefore evaluated the efficacy of 4 different LAA-closure techniques in patients undergoing cardiac surgery. Methods: In total, 149 patients who underwent concomitant LAA closure during cardiac surgery between 2015 and 2019 were included in this retrospective transesophageal echocardiography study. Four different LAA-closure techniques were evaluated: LAA clipping (n = 62), suture ligation (n = 28), stapler resection (n = 30), and surgical LAA excision (n = 29). Successful LAA closure was defined as absence of LAA perfusion and absence of a stump greater than 10 mm. Results: The mean patients age was 68.7 ± 9.4 years; 61.7% were male. No complications related to LAA closure were observed. Mean follow-up was 36.5 ± 8 months. Transesophageal echocardiography follow-up showed the following LAA closure success rates: LAA clip 98.4%, surgical excision 93.1%, stapler resection 76.6%, and suture ligation 39.2%. Suture ligation resulted in a high rate of recanalization (50%) and residual stumps (10.8%), whereas stapler resection resulted in a high rate of residual stumps (23.4%). Overall, 4 patients (2.7%) had a stroke during follow-up. In detail, 2 of 27 (7.4%) patients with unsuccessful LAA closure had a stroke, whereas 2 of the 122 (1.6%) patients with successful LAA closure had a stroke. Conclusions: In our study, LAA clipping and surgical LAA excision proved to be both successful LAA-closure methods. External LAA ligation and stapler resection resulted in low rates of successful LAA closure and should be avoided. |
| format | Article |
| id | doaj-art-30bdadfa31ca4a2588ced7892c37e1bc |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-30bdadfa31ca4a2588ced7892c37e1bc2025-08-20T03:38:24ZengElsevierJTCVS Techniques2666-25072024-08-0126434910.1016/j.xjtc.2024.05.007Efficacy of four different left atrial appendage closure techniques during cardiac surgery—A transesophageal echocardiography follow-up studyCentral MessagePerspectiveJohannes Petersen, MD0Henrike Böning, MD1Sevenai Yildirim, MD2Yousuf Alassar, MD3Yalin Yildirim, MD4Ilia Bazhanov, MD5Christoph Sinning, MD6Hermann Reichenspurner, MD, PhD7Simon Pecha, MD8Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, GermanyDepartment of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Address for reprints: Simon Pecha, MD, Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistr 52, 20246 Hamburg, Germany.Objective: Closure of the left atrial appendage (LAA) is a routine part of atrial fibrillation ablation surgery and significantly reduces stroke rates. Different LAA-closure techniques are used in cardiac surgery with variable results reported. We therefore evaluated the efficacy of 4 different LAA-closure techniques in patients undergoing cardiac surgery. Methods: In total, 149 patients who underwent concomitant LAA closure during cardiac surgery between 2015 and 2019 were included in this retrospective transesophageal echocardiography study. Four different LAA-closure techniques were evaluated: LAA clipping (n = 62), suture ligation (n = 28), stapler resection (n = 30), and surgical LAA excision (n = 29). Successful LAA closure was defined as absence of LAA perfusion and absence of a stump greater than 10 mm. Results: The mean patients age was 68.7 ± 9.4 years; 61.7% were male. No complications related to LAA closure were observed. Mean follow-up was 36.5 ± 8 months. Transesophageal echocardiography follow-up showed the following LAA closure success rates: LAA clip 98.4%, surgical excision 93.1%, stapler resection 76.6%, and suture ligation 39.2%. Suture ligation resulted in a high rate of recanalization (50%) and residual stumps (10.8%), whereas stapler resection resulted in a high rate of residual stumps (23.4%). Overall, 4 patients (2.7%) had a stroke during follow-up. In detail, 2 of 27 (7.4%) patients with unsuccessful LAA closure had a stroke, whereas 2 of the 122 (1.6%) patients with successful LAA closure had a stroke. Conclusions: In our study, LAA clipping and surgical LAA excision proved to be both successful LAA-closure methods. External LAA ligation and stapler resection resulted in low rates of successful LAA closure and should be avoided.http://www.sciencedirect.com/science/article/pii/S2666250724002281left atrial appendage closureatrial fibrillation therapystroke prevention |
| spellingShingle | Johannes Petersen, MD Henrike Böning, MD Sevenai Yildirim, MD Yousuf Alassar, MD Yalin Yildirim, MD Ilia Bazhanov, MD Christoph Sinning, MD Hermann Reichenspurner, MD, PhD Simon Pecha, MD Efficacy of four different left atrial appendage closure techniques during cardiac surgery—A transesophageal echocardiography follow-up studyCentral MessagePerspective JTCVS Techniques left atrial appendage closure atrial fibrillation therapy stroke prevention |
| title | Efficacy of four different left atrial appendage closure techniques during cardiac surgery—A transesophageal echocardiography follow-up studyCentral MessagePerspective |
| title_full | Efficacy of four different left atrial appendage closure techniques during cardiac surgery—A transesophageal echocardiography follow-up studyCentral MessagePerspective |
| title_fullStr | Efficacy of four different left atrial appendage closure techniques during cardiac surgery—A transesophageal echocardiography follow-up studyCentral MessagePerspective |
| title_full_unstemmed | Efficacy of four different left atrial appendage closure techniques during cardiac surgery—A transesophageal echocardiography follow-up studyCentral MessagePerspective |
| title_short | Efficacy of four different left atrial appendage closure techniques during cardiac surgery—A transesophageal echocardiography follow-up studyCentral MessagePerspective |
| title_sort | efficacy of four different left atrial appendage closure techniques during cardiac surgery a transesophageal echocardiography follow up studycentral messageperspective |
| topic | left atrial appendage closure atrial fibrillation therapy stroke prevention |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724002281 |
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