Surgical epicardial left atrial appendage closure:A true alternative

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Devices

Background:

• Historically, surgical left atrial appendage amputation was performed for stroke prevention.
• This early procedure by Madden in 1949 was highly invasive with suboptimal results.
• Interest shifted away from the left atrial appendage following the development of the Cox-Maze procedure.

Purpose of the Study:

• To review the historical context and evolution of left atrial appendage closure techniques.
• To highlight the resurgence of interest in left atrial appendage closure with modern approaches.

Main Methods:

• Historical review of surgical techniques for left atrial appendage management.
• Discussion of the impact of the Cox-Maze procedure on surgical focus.
• Examination of the advent and influence of catheter-based closure devices.

Main Results:

• The initial surgical approach to left atrial appendage amputation was invasive and associated with poor outcomes.
• The Cox-Maze procedure redirected surgical focus from appendage management.
• Catheter-based left atrial appendage closure has revitalized clinical and research interest in the field.

Conclusions:

• Left atrial appendage closure has evolved significantly from early invasive surgery to modern minimally invasive catheter-based techniques.
• The development of catheter-based options has been pivotal in re-establishing left atrial appendage closure as a key strategy for stroke prevention.