Ligation of the left atrial appendage using an automatic surgical stapler

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Surgical Innovation

Background:

• The left atrial appendage (LAA) is a common source of thromboembolism in conditions like atrial fibrillation.
• Surgical ligation of the LAA is a strategy to reduce stroke risk.
• Existing methods for LAA ligation can be complex or associated with complications.

Purpose of the Study:

• To evaluate the efficacy and safety of an automatic surgical stapler for LAA ligation.
• To assess the long-term outcomes of LAA obliteration using this device in an animal model.
• To determine the feasibility of this technique in human patients undergoing cardiac procedures.

Main Methods:

• Fourteen adult sheep underwent LAA ligation using a rotating-head surgical stapler with absorbable or stainless steel staples.
• Acute assessment (2 hours) and chronic assessment (90-100 days) were performed in sheep.
• The technique was subsequently applied to 5 human patients undergoing mitral valve procedures.

Main Results:

• In sheep, acute assessment showed no hemorrhage or intraatrial thrombus.
• Chronic assessment in sheep revealed complete LAA obliteration with no thrombus or staple migration; absorbable staples were fully reabsorbed.
• In patients, the procedure resulted in no complications and achieved adequate LAA obliteration.

Conclusions:

• Automatic surgical stapler ligation of the LAA is a safe and effective technique.
• This method provides complete obliteration of the LAA, reducing thromboembolic risk.
• The technique is feasible and well-tolerated in both animal models and human patients.