Contemporary left atrial appendage management during adult cardiac surgery

2023 APHRS expert consensus statements on surgery for AF

“…A study with transesophageal echocardiography of patients after LAA closure demonstrated the incidence of patent LAA was 29% after staple exclusion, while no patients with patent LAA after staple amputation. 115 A randomized comparison of internal ligation, stapled excision, and surgical excision of LAA demonstrated high incidences of incomplete closure after internal ligation (43%) and of residual LAA stump after stapled excision (25%) or surgical excision transesophageal echocardiography and cardiogenic thromboembolisms occurred in 0.25 patients per 100 patient-years during an average follow-up period of 24 months without anticoagulant therapy. 122 The incidence of ischemic stroke was 0.78 patients per 100 patient-years after a total thoracoscopic ablation with LAA closure using a stapler or a clip.…”

“…A randomized comparison of internal ligation, stapled excision, and surgical excision of LAA demonstrated high incidences of incomplete closure after internal ligation (43%) and of residual LAA stump after stapled excision (25%) or surgical excision (50%) assessed by transesophageal echocardiography at a mean of 0.4 years postoperatively and recommended intraoperative assessment of the closed LAA by transesophageal echocardiography. An endocardial longitudinal double‐layer obliteration has been proposed for the LAA closure based on the anatomical and pathological considerations 115 …”

“…A study with transesophageal echocardiography of patients after LAA closure demonstrated the incidence of patent LAA was 29% after staple exclusion, while no patients with patent LAA after staple amputation. 115 A randomized comparison of internal ligation, stapled excision, and surgical excision of LAA demonstrated high incidences of incomplete closure after internal ligation (43%) and of residual LAA stump after stapled excision (25%) or surgical excision (50%) assessed by transesophageal echocardiography at a mean of 0.4 years postoperatively and recommended intraoperative assessment of the closed LAA by transesophageal echocardiography. An endocardial longitudinal double‐layer obliteration has been proposed for the LAA closure based on the anatomical and pathological considerations.…”

“…An endocardial longitudinal double‐layer obliteration has been proposed for the LAA closure based on the anatomical and pathological considerations. 115 …”