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Updated: Aug 16, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Surgical closure of the left atrial appendage - a beneficial procedure?
Birke Schneider1, Claudia Stollberger, Hans H Sievers
1Klinik fur Kardiologie, Sana Kliniken Lubeck GmbH, Deutschland. b.schneider@sana-luebeck.de
Insights
Surgical closure of the left atrial appendage (LAA) was often incomplete, leading to blood stagnation and clot formation. This highlights the need for intraoperative transesophageal echocardiography to ensure complete LAA obliteration and reduce stroke risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Surgical left atrial appendage (LAA) closure is recommended during valve surgery to prevent arterial embolism.
- Systematic reevaluation for complete LAA obliteration after surgical closure is lacking.
Purpose of the Study:
- To assess the completeness of surgical LAA closure in patients undergoing valve surgery.
- To evaluate the impact of incomplete LAA closure on thromboembolic events.
Main Methods:
- A prospective study of 6 consecutive patients with atrial fibrillation undergoing surgical LAA closure during valve surgery.
- Postoperative transesophageal echocardiography (TEE) was performed to assess LAA obliteration.
Main Results:
- Complete LAA closure was achieved in only 1 of 6 patients.
- Incomplete closure was observed in 5 patients, with residual LAA orifices ranging from 3-20 mm.
- Incomplete closure led to blood stagnation, spontaneous echocardiographic contrast, new thrombus formation, and one stroke event.
Conclusions:
- Surgical LAA closure is frequently incomplete, potentially increasing stroke risk.
- Incomplete closure results in blood stagnation and heightened risk of clot formation.
- Intraoperative TEE is essential to confirm complete LAA obliteration.
Background:
Closure of the fibrillating left atrial appendage (LAA) has been recommended during valve surgery to decrease the risk of arterial embolism. However, patients undergoing surgical LAA closure have not systematically been reevaluated for complete LAA obliteration.
Methods And Results:
During a 12-month period, we studied 6 consecutive patients with paroxysmal (n = 3) or permanent (n = 3) atrial fibrillation who underwent surgical LAA closure at the time of valve surgery. Transesophageal echocardiography (TEE) performed 23-159 days (mean 51) postoperatively demonstrated complete LAA closure in only 1 patient. In 5 patients, incomplete LAA closure was found due to disruption of the closure line. The size of the residual LAA orifice ranged from 3 to 20 mm. There was a high flow velocity at the LAA orifice (0.33-2.2 m/s), whereas flow in the LAA body was low (<0.2 m/s). Spontaneous echocardiographic contrast (SEC) in the LAA had newly developed (n = 3) or was much more intense than preoperatively (n = 2). Despite therapeutic anticoagulation 2 patients showed a LAA thrombus which had not been present on the preoperative TEE, and 1 patient with SEC suffered a stroke 4 weeks after attempted LAA closure.
Conclusion:
Surgical LAA closure was incomplete in most patients, resulting in blood stagnation and an increased likelihood of clot formation. Incomplete surgical LAA closure, therefore, may promote rather than reduce the risk of stroke. Intraoperative TEE is mandatory to verify complete LAA obliteration.
