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. 2023 Jun 20;23(1):308.
doi: 10.1186/s12872-023-03330-8.

The completeness of the left atrial appendage amputation during routine cardiac surgery

Dejan Radakovic  1 , Kiril Penov  2 , Marc Lazarus  3 , Nodir Madrahimov  2 , Khaled Hamouda  2 , Christoph Schimmer  2 , Rainer G Leyh  2 , Constanze Bening  2
Affiliations

The completeness of the left atrial appendage amputation during routine cardiac surgery

Dejan Radakovic et al. BMC Cardiovasc Disord. .

Abstract

Background: Left atrial appendage (LAA) is the origin of most heart thrombi which can lead to stroke or other cerebrovascular event in patients with non-valvular atrial fibrillation (AF). This study aimed to prove safety and low complication rate of surgical LAA amputation using cut and sew technique with control of its effectiveness.

Methods: 303 patients who have undergone selective LAA amputation were enrolled in the study in a period from 10/17 to 08/20. The LAA amputation was performed concomitant to routine cardiac surgery on cardiopulmonary bypass with cardiac arrest with or without previous history of AF. The operative and clinical data were evaluated. Extent of LAA amputation was examined intraoperatively by transoesophageal echocardiography (TEE). Six months in follow up, the patients were controlled regarding clinical status and episodes of strokes.

Results: Average age of study population was 69.9 ± 19.2 and 81.9% of patients were male. In only three patients was residual stump after LAA amputation larger than 1 cm with average stump size 0.28 ± 0.34 cm. 3 patients (1%) developed postoperative bleeding. Postoperatively 77 (25.4%) patients developed postoperative AF (POAF), of which 29 (9.6%) still had AF at discharge. On 6 months follow up only 5 patients had NYHA class III and 1 NYHA class IV. Seven patients reported with leg oedema and no patient experienced any cerebrovascular event in early postoperative follow up.

Conclusion: LAA amputation can be performed safely and completely leaving minimal to no LAA residual stump.

Keywords: Atrial fibrillation; Cut and sew technique; Left atrial appendage occlusion.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A – Before LAA amputation there is color low jet observed between the atrium and appendage suggesting persistent flow into left atrial appendage. B – after left atrial appendage is excised in same patient stump remains < 1 cm; measured 0.313 cm exactly
Fig. 2
Fig. 2
Kidney function before and after surgery. A – serum creatine levels. B - Glomerular filtration rate
See this image and copyright information in PMC

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