Related Experiment Video
Updated: Jul 10, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Surgical left atrial appendage closure: Success rate and its relationship with cerebrovascular accident
Mohammad Mahdi Peighambari1, Firoozeh Moradkarami2, Anita Sadeghpour2
1Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
The purse-string and resection methods show the highest success rates for surgical left atrial appendage (LAA) closure. Postoperative cerebrovascular accident (CVA) risk is linked to clots on metallic valves, not partial LAA closure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Surgical closure of the left atrial appendage (LAA) is often performed after mitral valve surgery.
- Techniques include excision, exclusion, purse-string, resection, and ligation.
Purpose of the Study:
- Evaluate surgical LAA closure techniques.
- Assess complication rates.
- Determine the incidence of post-surgical cerebrovascular accident (CVA).
Main Methods:
- Retrospective study of 150 patients undergoing LAA closure.
- Data collected on closure method, CVA history, prosthetic valves, mortality, and bleeding.
- Echocardiographic assessment of LAA closure.
Main Results:
- Complete LAA closure failure rate was 36.7%.
- Purse-string (75.5%) and resection (71.4%) methods had the highest success rates.
- Postoperative CVA significantly correlated with clots on metallic valves (P=0.001).
Conclusions:
- Purse-string and resection are the most successful LAA closure techniques.
- Partial LAA closure did not correlate with increased CVA risk.
- CVA occurrence is primarily associated with metallic valve clots, not residual LAA clots.
Abstract:
Background: Several surgical procedures such as excision or exclusion are recommended for the closure of the left atrial appendage (LAA). This study was conducted with the aim to evaluate the success rate of different surgical techniques for LAA closure, their respective complications, and the rate of post-surgical cerebrovascular accident (CVA). Methods: This retrospective study included 150 consecutive patients who underwent LAA closure most commonly after mitral valve surgery within 3 to 6 months after surgery. An expert echocardiographic fellow collected the data on patients' surgical LAA closure methods and history of CVA, types of prosthetic valves, mortality, and bleeding. Results: The failure rate for complete LAA closure was 36.7% (55 patients) in our study. The greatest success rate of complete LAA closure was seen in purse-string method (75.5%), followed by resection method (71.4%), while the lowest success rate (≈ 33.3%) was observed in ligation method. A significant relationship was observed between clots on the surface of metallic valve and postoperative CVA (P = 0.001; likelihood ratio: 32).In multivariate analysis, there was also no statistically significant relationship between partial LAA closure and the incidence of post-surgical CVA (P > 0.050). Conclusion: We observed the highest success rate of complete LAA closure in purse-string method followed by resection method. Interestingly, our results showed that despite the higher rate of residual LAA clot in cases of partial LAA closure, the occurrence of post-surgical CVA was mostly related to the presence of clots on the surface of metallic mitral prostheses rather than the presence of partial LAA closure.
