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Related Experiment Videos

The left atrial appendage: our most lethal human attachment! Surgical implications.

W D Johnson1, A K Ganjoo, C D Stone

  • 1Department of Cardiovascular Surgery, St. Francis Hospital, 3300 South 16th Street, Milwaukee, WI 53215, USA. life@johnsonheartcare.com

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|June 17, 2000
PubMed
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Surgical removal of the left atrial appendage can prevent deadly emboli in atrial fibrillation patients. This procedure is safe during open-heart surgery and technically feasible via a minimally invasive approach for those with chronic atrial fibrillation.

Area of Science:

  • Cardiology
  • Surgical Innovation
  • Embolic Stroke Prevention

Background:

  • Atrial fibrillation significantly increases stroke risk, with over 90% of embolic strokes originating from the left atrial appendage.
  • The left atrial appendage is a primary source of emboli responsible for atrial fibrillation-related deaths.

Purpose of the Study:

  • To evaluate the surgical feasibility and safety of left atrial appendage removal (appendectomy) in preventing embolic strokes.
  • To assess prophylactic appendectomy during open-heart surgery and therapeutic appendectomy in chronic atrial fibrillation patients.

Main Methods:

  • Experimental thorascopic appendectomy in goats demonstrated successful closure with stapling.
  • Safety of human appendectomy was assessed in 437 patients undergoing open-heart surgery (1995-1997).

Related Experiment Videos

  • Technical feasibility of thorascopic appendectomy was demonstrated in seven patients with chronic atrial fibrillation.

    • Main Results:

    • Prophylactic appendectomy during open-heart surgery showed no acute bleeding or identified late complications.
    • Thorascopic appendectomy was successfully performed in seven patients with chronic atrial fibrillation.
    • Stapling or suture closure resulted in cleaner, non-puckered atrial closure compared to purse-string techniques.

    Conclusions:

    • Left atrial appendage removal is a viable strategy to prevent emboli in atrial fibrillation patients.
    • Prophylactic appendectomy during open-heart surgery is recommended to mitigate future stroke risk.
    • Minimally invasive thorascopic appendectomy is a feasible approach for chronic atrial fibrillation patients, with further studies planned to confirm stroke prevention efficacy.