Surgical Closure of the Left Atrial Appendage: The Past, The Present, The Future

Area of Science:

• Cardiology
• Vascular Surgery

Background:

• Left atrial appendage (LAA) occlusion is a strategy to prevent stroke in patients with atrial fibrillation.
• Percutaneous LAA closure devices show efficacy, but surgical methods have yielded mixed results.
• Surgical exclusion via sutures or staplers is often ineffective due to LAA recanalization.

Purpose of the Study:

• To assess the efficacy of surgical LAA occlusion for stroke prevention in patients with atrial fibrillation.
• To evaluate the potential benefit of prophylactic LAA closure during cardiac surgery for high-risk patients.
• To investigate LAA occlusion in non-atrial fibrillation surgical patients at risk for developing it post-operatively.

Main Methods:

• Surgical LAA occlusion techniques include excision and specific devices (e.g., AtriClip) for complete closure.
• The Left Atrial Appendage Occlusion Study (LAAOS) III is a large trial assessing surgical LAA occlusion efficacy.
• The ATLAS trial investigates LAA occlusion in surgical patients without atrial fibrillation but at risk.

Main Results:

• Surgical excision and certain devices like AtriClip achieve complete LAA closure.
• Data on routine prophylactic LAA closure during cardiac surgery is currently lacking.
• Ongoing trials (LAAOS III, ATLAS) aim to provide crucial data on LAA occlusion efficacy.

Conclusions:

• Effective surgical LAA occlusion methods exist, offering an alternative for stroke prevention.
• Further research is needed to establish the role of prophylactic LAA closure in cardiac surgery.
• Results from LAAOS III and ATLAS will guide future clinical practice for LAA occlusion in stroke prevention.