Left atrial appendage clip causing left main coronary artery occlusion and mortality despite removal

An 80 year old man underwent coronary bypass to the left anterior descending and posterior descending arteries, ablation and left atrial appendage clipping. Weaning from bypass was complicated by global left ventricular dysfunction, and the clip was removed with improvement in ventricular function. The clip had been placed away from the circumflex artery and was not at or below the base of the appendage. The patient had recurrent low cardiac output postoperatively, and cardiac catheterization showed midshaft occlusion of the left main coronary artery where the removed appendage clip had damaged the artery. This report is the first to show that even removed left atrial appendage clips can result in lasting coronary artery damage including to the left main, and that any clip-related hemodynamic problems in the operating room should be followed by prompt cardiac catheterization. This report also shows that it is not only circumflex injury, but left main coronary injury, that can result from left atrial appendage clips.