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Updated: Jul 17, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Medium-to-long-term success rate of left atrial appendage closure using endocardial sutures and postoperative
Wenzhong Heng1, Hongying Song2, Rong Zhang3
1Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China.
Insights
Surgical closure of the left atrial appendage (LAA) using endocardial sutures is highly effective long-term for atrial fibrillation patients. While 90% achieved closure, residual flow requires monitoring for thrombus risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Left atrial appendage (LAA) closure aims to reduce thromboembolic risk in atrial fibrillation (AF) patients.
- Limited data exists on the medium-to-long-term durability of surgical LAA closure.
Purpose of the Study:
- To evaluate the efficacy and safety of endocardial suture closure of the LAA during cardiac surgery.
- To assess the medium-to-long-term durability of this LAA closure technique.
Main Methods:
- Retrospective study of 50 patients with valvular heart disease and AF undergoing valve surgery, Cox-Maze IV, and LAA closure.
- Intraoperative and follow-up echocardiography (TEE and transthoracic) used to assess closure.
- Closure failure defined by residual stump >1 cm or residual to-and-fro flow.
Main Results:
- Mean follow-up was 7.16 years; 90.0% achieved successful LAA closure.
- No residual stump >1 cm, but 10.0% had residual to-and-fro flow.
- 80.0% of those with residual flow developed thrombus; one ischemic stroke occurred in this subgroup.
Conclusions:
- Endocardial suture LAA closure demonstrates high medium-to-long-term success rates.
- Residual to-and-fro flow, even without a significant stump, is clinically relevant due to thrombus risk.
- Findings are hypothesis-generating; anticoagulation decisions require individualized assessment.
Introduction:
Surgical endocardial closure of the left atrial appendage (LAA) may reduce thromboembolic risk in patients with atrial fibrillation (AF); however, evidence regarding its medium-to-long-term durability remains limited. This study evaluated the efficacy and safety of endocardial suture closure of the LAA during concomitant cardiac surgery.
Methods:
This retrospective study included 50 patients with valvular heart disease and AF who underwent valve surgery, the Cox-Maze IV procedure, and LAA closure using an endocardial suture technique between 2013 and 2018. Intraoperative transesophageal echocardiography (TEE) was used to assess immediate closure. Transthoracic echocardiography and TEE were performed during follow-up. Closure failure was defined as a residual LAA stump >1 cm or residual to-and-fro flow between the left atrium and LAA.
Results:
The mean follow-up duration was 7.16 ± 1.73 years. Intraoperative TEE showed no residual LAA stump or to-and-fro flow in any patient. At follow-up, no patient had a residual stump >1 cm, whereas residual to-and-fro flow was detected in 5 patients (10.0%), corresponding to a medium-to-long-term closure success rate of 90.0%. Four of these five patients (80.0%) developed thrombus within the residual LAA stump, and one experienced an ischemic stroke. No stroke occurred among patients with imaging-confirmed successful LAA closure.
Discussion:
Endocardial suture closure provided a high medium-to-long-term imaging success rate in this single-center cohort. Residual to-and-fro flow, even in the absence of a stump >1 cm, may be clinically relevant because it was frequently accompanied by thrombus formation. These findings should be interpreted as hypothesis-generating because of the limited sample size and low event rate. Postoperative anticoagulation decisions should remain individualized and guideline-informed.
