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Updated: Jul 26, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The completeness of the left atrial appendage amputation during routine cardiac surgery
Dejan Radakovic1, Kiril Penov2, Marc Lazarus3
1Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany. Radakovic_D@UKW.de.
Insights
Surgical left atrial appendage (LAA) amputation is a safe and effective procedure for reducing stroke risk in atrial fibrillation (AF) patients. This study demonstrated a low complication rate and no cerebrovascular events post-amputation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- The left atrial appendage (LAA) is a primary source of thrombi in non-valvular atrial fibrillation (AF) patients, increasing stroke risk.
- Surgical LAA amputation is a potential strategy to mitigate these risks.
Purpose of the Study:
- To evaluate the safety and effectiveness of surgical LAA amputation using a cut-and-sew technique.
- To assess the complication rates and clinical outcomes of LAA amputation.
Main Methods:
- 303 patients underwent selective LAA amputation during cardiac surgery between October 2017 and August 2020.
- Transesophageal echocardiography (TEE) assessed amputation extent; clinical data and stroke episodes were monitored for six months post-surgery.
Main Results:
- The average LAA stump size was minimal (0.28 cm), with only 3 patients having stumps >1 cm.
- A low complication rate was observed: 1% postoperative bleeding and 25.4% new-onset postoperative AF (POAF), with 9.6% persistent at discharge.
- No cerebrovascular events occurred during the follow-up period; functional status improved, with only 6 patients in NYHA class III/IV at 6 months.
Conclusions:
- Surgical LAA amputation is a safe and effective procedure.
- The cut-and-sew technique allows for complete amputation with minimal residual stump, reducing stroke risk.
Background:
Left atrial appendage (LAA) is the origin of most heart thrombi which can lead to stroke or other cerebrovascular event in patients with non-valvular atrial fibrillation (AF). This study aimed to prove safety and low complication rate of surgical LAA amputation using cut and sew technique with control of its effectiveness.
Methods:
303 patients who have undergone selective LAA amputation were enrolled in the study in a period from 10/17 to 08/20. The LAA amputation was performed concomitant to routine cardiac surgery on cardiopulmonary bypass with cardiac arrest with or without previous history of AF. The operative and clinical data were evaluated. Extent of LAA amputation was examined intraoperatively by transoesophageal echocardiography (TEE). Six months in follow up, the patients were controlled regarding clinical status and episodes of strokes.
Results:
Average age of study population was 69.9 ± 19.2 and 81.9% of patients were male. In only three patients was residual stump after LAA amputation larger than 1 cm with average stump size 0.28 ± 0.34 cm. 3 patients (1%) developed postoperative bleeding. Postoperatively 77 (25.4%) patients developed postoperative AF (POAF), of which 29 (9.6%) still had AF at discharge. On 6 months follow up only 5 patients had NYHA class III and 1 NYHA class IV. Seven patients reported with leg oedema and no patient experienced any cerebrovascular event in early postoperative follow up.
Conclusion:
LAA amputation can be performed safely and completely leaving minimal to no LAA residual stump.
