Noninvasive imaging to confirm the technical outcomes of left atrial appendage exclusion following surgical closure

Closure of the left atrial appendage in patients with atrial fibrillation significantly decreases the rate of future complications. Exclusion success is typically evaluated via transesophageal echocardiography, an invasive procedure typically requiring patient sedation. We investigated left atrial appendage (LAA) exclusion rates postoperatively utilizing cardiac computed tomography (CT).

We conducted a retrospective review of patients who underwent surgical LAA closure. Closure techniques were compared utilizing postoperative cardiac CT. Successful closure was defined by remnant pouch <1 cm and absence of distal contrast flow. Rates of postoperative reintervention, thromboembolic events, and anticoagulation usage were also assessed.

Seventy-nine patients underwent surgical LAA closure and completed postoperative cardiac CT. Successful exclusion was seen in 60 of 64 patients (93.8%) receiving an epicardial-placed occlusion device and 12 of 15 (80%) undergoing primary surgical closure (2/2, 100%, pericardial patch; 10/13, 76.9%, internal suture ligation). Four exclusion failures of epicardial-placed occlusion devices were characterized by residual stump. Three failures with internal suture ligation were described as patent left atrial appendage orifice.

Primary surgical closure trended toward a higher imaging failure rate compared to an epicardial occlusion device. Noninvasive CT imaging was useful to evaluate successful LAA closure. The ability to identify exclusion failure allows surgeons to refine operative techniques.