Left Atrial Appendage Removal May Not Always Prevent Stroke

September 9, 2008 6:23 AM CT

A study recently published in the Journal of the American College of Cardiology evaluated 137 patients who had undergone surgical closure or removal of the left atrial appendage (LAA) and found a high failure rate and that surgical LAA closure may not protect against clots or strokes.

In the study, the LAA was closed by surgical excision (removal) in 52 patients (38%), by suture exclusion (closing off) in 73 (53%), and by stapler exclusion in 12 (9%).

Success rates:
Surgical excision – 38 (73%)
Suture exclusion – 17 (27%)
Stapler exclusion –  0 ( 0%)

In the postoperative evaluation using transesophageal echocardiography (TEE), 41% of patients with failed LAA exclusion had LAA clots, but none with excision had clots.

Postoperative strokes or TIAs were reported in 6 with LAA excision, 11 with suture exclusion, and 1 with stapler exclusion. Of the 55 patients with a successful LAA closure, 6 (11%) had a postoperative stroke or TIA versus 12 of the 82 (15%) with unsuccessful LAA closure.

The study concluded that surgical LAA closure has a high failure rate, but that surgical excision appears to be preferable to suture or stapler. It also suggests that incomplete or failed closure puts us at significant risk, and thus surgical LAA closure may not protect against clots or strokes.

Read the full study results here at Success of Surgical Left Atrial Appendage Closure: Assessment by Transesophageal Echocardiography…

Thus, if you are planning to have a maze or mini maze surgery, you need to discuss with your surgeon how he or she will deal with the left atrial appendage. Fortunately, new closures are now available that were not available during this study, but you cannot be too careful in evaluating every detail before your surgery.