Closure of the Left Atrial Appendage During Cardiac Surgery　– Why, When and How? –

Bando, Ko; Hara, Kazuhiro

doi:10.1253/circj.cj-15-1168

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Forty one percent of unsuccessfully closed LAA developed an atrial thrombus (12)(13)(14). In a study of Kanderian (6) ligature of the LAA was performed in 72 patients.…”

Section: Discussionmentioning

confidence: 99%

Epicardial left atrial appendage closure—comparison of surgical techniques in an ex vivo model

Mirow¹,

Vogt²,

Irqsusi³

et al. 2017

J. Thorac. Dis.

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Background: Formation of clots in the left atrial appendage (LAA) may lead to embolism and consecutive cerebral stroke. This risk is reduced by closure and resection. To address the efficacy of surgical LAA closure, resilience to pneumatic pressure was studied. Different surgical techniques were compared in an experimental model. Methods:From freshly slaughtered pigs cardiopulmonary preparations were taken. The left atrium was clamped airtight and the LAA was cannulated. Via a manually operated pump pressure was applied and a digital pressure gauge was connected. Four groups (each n=12) with different epicardial closures were studied: (I) purse string; (II) single layered continuous suture; (III) double layered suture; (IV) surgical stapler. A nonparametric test was used for group comparisons of mean burst pressures (mmHg). Statistical significance was defined at P<0.05.Results: Mean burst pressures in group 1 amounted to 97.1±13.0 mmHg, in group 2 to 105.5±13.3 mmHg, in group 3 to 124.6±14.2 mmHg and in group 4 to 136.6±12.5 mmHg. Excepting differences between groups 1 and 2 comparisons between groups were significantly different. Conclusions:In an ex vivo model surgical staplers and double layered hand crafted sutures proved well suitable for closure of the LAA. They were significantly superior to single layered sutures in terms of resilience to pneumatic pressure. This may be relevant to durability and should be discussed with regard to clinical choice. In an attempt for systematic approach in our experimental study we examined different surgical closure techniques in terms of resistance to pressure immediately after the procedure. Results of the study may contribute to a better understanding of factors influencing the quality of left atrial appendage (LAA) closure, eventually leading to clinical preference. MethodsAn experimental model of an isolated left heart was developed, reproducibly facilitating pneumatic pressure measurements in the left atrium. As neither patients nor living animals were part of the study concept, no ethics approval was required. From commercially slaughtered pigs (nutritional purposes, weight EU-standard: 90 kg), fresh heart and lungs packages were removed. The packages were carefully inspected for anatomic integrity, immediately cooled and taken to the laboratory. The pulmonary artery and the aorta were isolated; the ligament of Botalli was severed. The pulmonary artery was cut above the pulmonary valve; the ascending aorta was cut proximal to the aortic arch. The ascending aorta was crossclamped, as were both coronary arteries near their origins from the aorta. The heart was lifted as a whole and the left atrium was clamped at the inlets of the pulmonary veins. A cannula (Sorin Group, Milano, Italy) was inserted into the roof of the left atrium 3 to 4 cm from the origin of the LAA and secured with two purse-strings. (Prolene 4-0, Johnson & Johnson Medical Ltd., Ethicon Germany, Norderstedt, Germany). The cannula was connected to a digital manometer Greisinger Company, Regenstau...

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“…Forty one percent of unsuccessfully closed LAA developed an atrial thrombus (12)(13)(14). In a study of Kanderian (6) ligature of the LAA was performed in 72 patients.…”

Section: Discussionmentioning

confidence: 99%

Epicardial left atrial appendage closure—comparison of surgical techniques in an ex vivo model

Mirow¹,

Vogt²,

Irqsusi³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

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“…24,25) Surgical LAAC is divided into two categories: exclusion or excision. 26,27) Epicardial surface exclusion includes running or mattress sutures with or without felt pledgets, purse-string sutures from the epicardial surface, or running sutures or purse-string sutures from the endocardial surface, and single ligation techniques. Excision procedures include a stapled excision, or oversew, and removal techniques.…”

Section: Current Evidence Derived From Surgical Laa Occlusionmentioning

confidence: 99%

The Efficacy and Safety of the WATCHMAN Device in LAA Occlusion in Patients with Non-Valvular Atrial Fibrillation Contraindicated to Oral Anticoagulation: A Focused Review

Majule

Chang

Rutahoile

et al. 2018

ATCS

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The standard treatment for stroke risk patients with non-valvular atrial fibrillation (NVAF) is the use of oral anticoagulants (OACs). However, a substantial number of patients have relative or absolute contraindications to OACs due to concerns of major bleeding risk and other adverse effects while using oral anticoagulation therapy. Recently, occurrences of exclusion of the left atrial appendage (LAA) in patients with contraindication to anticoagulation therapy are widely expanding worldwide, causing major contentious discussions. The LAA is the commonest place of thrombus formation; therefore, the concept of LAA occlusion in reducing stroke and other embolic events in NVAF patients is very important. The current understanding of the available evidence on efficacy and safety of LAA closure (LAAC) with the Watchman device in patients contraindicated to OACs is the major aim of this focused review. After reviewing a significant body of literature, a world experience with no randomized trials, it is suggested that Watchman device implantation is effective and safe in high-risk patients with NVAF contraindicated to OACs therapy.

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Closure of the Left Atrial Appendage During Cardiac Surgery　– Why, When and How? –

Cited by 2 publications

References 18 publications

Epicardial left atrial appendage closure—comparison of surgical techniques in an ex vivo model

Epicardial left atrial appendage closure—comparison of surgical techniques in an ex vivo model

The Efficacy and Safety of the WATCHMAN Device in LAA Occlusion in Patients with Non-Valvular Atrial Fibrillation Contraindicated to Oral Anticoagulation: A Focused Review

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Closure of the Left Atrial Appendage During Cardiac Surgery – Why, When and How? –

Cited by 2 publications

References 18 publications

Epicardial left atrial appendage closure—comparison of surgical techniques in an ex vivo model

Epicardial left atrial appendage closure—comparison of surgical techniques in an ex vivo model

The Efficacy and Safety of the WATCHMAN Device in LAA Occlusion in Patients with Non-Valvular Atrial Fibrillation Contraindicated to Oral Anticoagulation: A Focused Review

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Closure of the Left Atrial Appendage During Cardiac Surgery　– Why, When and How? –