Left Atrial Appendage Thrombus After Successful Surgical Exclusion on Anticoagulation: A Need for Closer Postintervention Monitoring

A randomized, prospective pilot comparison of 3 atrial appendage elimination techniques: Internal ligation, stapled excision, and surgical excision

“…It has been demonstrated that even in ''successful'' LAA closure with a stump of <1 cm on anticoagulation, thrombus may be present. 15 Subsequently, some now recommend evaluating all patients by TEE before the decision to eliminate anticoagulation. This study has several limitations.…”

Modified internal ligation of the left atrial appendage

“…3 In the Left Atrial Appendage Occlusion Study, the reported bleeding rate was 17.3%, occurring primarily from external manipulation. 4 With regard to external clips, as we have previously reported, 5 thrombus formation can still occur on a stump smaller 1 cm, which is defined as ''successful'' exclusion by the criteria outlined by Kanderian and colleagues. 6 The technique described here accomplishes a smoother surface and virtually no stump, which may decrease the substrate for thrombus formation.…”

Contemporary left atrial appendage management during adult cardiac surgery

“…Although a goal of <10 mm should be the minimum objective, near complete stump reduction by intraoperative transesophageal echocardiography should be the goal because residual thrombus in the fibrillating atrium may occur with any size stump. 18 A serious, but unusual complication of epicardial clip or stapling procedures can be the inadvertent incorporation of adjacent epicardial fat and tissue that may result in partial kinking or obstruction of the circumflex coronary artery. 19 These anatomically related complications may be avoided by preoperative and intraoperative imaging and careful intraoperative anatomic assessment of the LAA to confirm that the neck and base are favorable for successful device deployment.…”