Surgical Left Atrial Appendage Exclusion Does Not Impair Left Atrial Contraction Function: A Pilot Study

Abstract

Background. In order to reduce stroke risk, left atrial appendage amputation (LAAA) is widely adopted in recent years. The effect of LAAA on left atrial (LA) function remains unknown. The objective of present study was to assess the effect of LAAA on LA function. Methods. Sixteen patients with paroxysmal AF underwent thoracoscopic, surgical PVI with LAAA (LAAA group), and were retrospectively matched with 16 patients who underwent the same procedure without LAA amputation (non-LAAA group). To objectify LA function, transthoracic echocardiography with 2D Speckle Tracking was performed before surgery and at 12 months follow-up. Results. Mean age was 57 ± 9 years, 84% were male. Baseline characteristics did not differ significantly except for systolic blood pressure (p = 0.005). In both groups, the contractile LA function and LA ejection fraction were not significantly reduced. However, the conduit and reservoir function were significantly decreased at follow-up, compared to baseline. The reduction of strain and strain rate was not significantly different between groups. Conclusions. In this retrospective, observational matched group comparison with a convenience sample size of 16 patients, findings suggest that LAAA does not impair the contractile LA function when compared to patients in which the appendage was unaddressed. However, the LA conduit and reservoir function are reduced in both the LAAA and non-LAAA group. Our data suggest that the LAA can be removed without late LA functional consequences.

The Effect of Minimally Invasive Thoracoscopic Left Atrial Appendage Excision on Cardiac Dynamic and Endocrine Function

“…Several studies have reported that LAA contractile function contributes greatly to LA transport function. Benussi et al 26) studied the effects of LAA amputation on left atrial function in the setting of minimally invasive surgical pulmonary vein isolation and found that the LA reservoir and conduit function are impaired after procedure. This might contribute to the decreased LA compliance resulting from the postoperative adhesions of the pericardium and/or atrial surgical scarring.…”

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

“…Thrombus is formed in the left atrial appendage (LAA) in up to 90% of cases, which may lead to embolism (1,4). To prevent this, the LAA may be closed either surgically or interventionally (1,5).…”

Pneumatic Burst Pressures After Inverted Closure of the Left Atrial Appendage: An Ex Vivo Model

“…Various surgical techniques are applicable from an external, epicardial approach as well as from an internal, endocardial approach. Externally, the spectrum includes simple ligature or surgical suturing at the base, surgical stapling [14][15][16], and clipping with an AtriClip commercial device (AtriCure, West Chester, OH) [5,[17][18][19][20][21], which is Conformit e Europ eene marked and U.S. Food and Drug Administration approved. External, epicardial techniques are used in combination with other cardiac procedures or as stand-alone procedures, which can also be performed in a minimally invasive manner [22][23][24].…”