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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
Summary
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).
- 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.