Why should cardiac surgeons occlude the left atrial appendage percutaneously?

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Percutaneous left atrial appendage occlusion (LAAO) is typically performed by cardiologists.
• This study investigates the feasibility and outcomes of LAAO performed exclusively by cardiac surgeons.

Purpose of the Study:

• To evaluate the safety and efficacy of percutaneous LAAO when performed solely by cardiac surgeons.
• To compare outcomes of LAAO performed by surgeons versus predicted risks.

Main Methods:

• A total of 223 patients with nonvalvular atrial fibrillation underwent percutaneous LAAO at two cardiac surgery centers.
• Procedures utilized either endocardial occluders (Amulet, LAmbre) or the epicardial LARIAT device.
• Data collected included procedural success, adverse events, and long-term follow-up.

Main Results:

• The procedure demonstrated a high success rate of 97.3%.
• Procedural or device-related adverse events occurred in 4.4% of cases.
• Long-term follow-up showed a 71% reduction in thromboembolism and a 69% reduction in bleeding compared to predicted risks.

Conclusions:

• Percutaneous LAAO can be safely and effectively performed by cardiac surgeons without cardiological assistance.
• Both endocardial and epicardial LAAO techniques are feasible for cardiac surgeons.
• Training cardiac surgeons in LAAO procedures is recommended.