Modified internal ligation of the left atrial appendage

Abstract

Central MessageThe search for a reliable and durable surgical technique for exclusion of the left atrial appendage remains relevant in light of contemporary data.

Ligating the left atrial appendage in atrial fibrillation: What additional evidence do surgeons need?

“…Knowing the modes of S-LAAO failure provides a starting point for exploring techniques to improve outcomes. In fact, attention to technique of the internal ligation method has been described and discussed, 8,14 but widespread adoption of such modifications is unknown at this time. An individualized approach accounting for concomitant procedures, exposure, anatomy, and tissue integrity is more important than whether any one particular method has evidence to support it as a superior method.…”

Mechanical occlusion of the left atrial appendage — lessons from surgical experience

“…The important lesson was that types of failure varied by technique. In the case of internal ligation, residual gaps and internal flow communications developed, probably owing to tension on the internal suture over time 9 . The contribution of atrial size and contractility is not yet known.…”

It ain't closed 'til it's closed

“…Probable causes of failure include variations in LAA anatomy and the beating nature of the chamber. 2 In this issue of the Journal, Hui and Lee 3 from Saint Louis University present a modified method for performing the internal suture closure of the LAA orifice that has been used in 23 patients at the time of their report. The method adds a so-called ''compression stitch,'' which obliterates the LAA lumen by suturing the internal side of the tip of the LAA to its base after inverting the LAA.…”