Efficacy of four different Left atrial Appendage closure techniques during cardiac surgery-A transesophageal echocardiography follow-up study

Objectives Closure of left- atrial appendage (LAA) is a routine part of AF ablation surgery and significantly reduces stroke rates. Different LAA closure techniques are used in cardiac surgery with variable results. We therefore evaluated the efficacy of four different LAA closure techniques in patients undergoing cardiac surgery. Methods 149 patients who underwent concomitant LAA closure during cardiac surgery between 2015 and 2019 were included in this retrospective transesophageal echocardiography (TEE) study. Four different LAA closure techniques were evaluated: LAA clipping (n=62), suture ligation (n=28), stapler resection (n=30), surgical LAA excision (n=29). Successful LAA closure was defined as absence of LAA perfusion and absence of a stump >10 mm. Results The mean patients age was 68.7 ± 9.4 years, 61.7% were male. No complications related to LAA closure were observed. Mean follow-up was 36.5±8 months. TEE follow-up showed the following LAA closure success rates: LAA clip 98.4%, surgical excision 93.1%, stapler resection 76.6% and suture ligation 39.2%. Suture ligation resulted in a high rate of recanalisation (50%) and residual stumps (10.8%), whereas stapler resection resulted in a high rate of residual stumps (23.4%). Overall, four patients (2.7%) had a stroke during follow-up. In detail, 2 of 27 (7.4%) patients with unsuccessful LAA closure had a stroke, whereas 2 of the 122 (1.6%) patients with successful LAA closure had a stroke. Conclusions In our study, LAA clipping and surgical LAA excision have proven to be both successful LAA closure methods. External LAA ligation and stapler resection resulted in low rates of successful LAA closure and should be avoided.