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. 2023 Jun 27;24(6):184.
doi: 10.31083/j.rcm2406184. eCollection 2023 Jun.

Different Techniques of Surgical Left Atrial Appendage Closure and Their Efficacy: A Systematic Review

Mizar D'Abramo  1 , Silvia Romiti  1 , Sara Saltarocchi  1 , Wael Saade  1 , Flaminia Spunticchia  1 , Noemi Bruno  1 , Mariangela Peruzzi  1   2 , Fabio Miraldi  1 , Giacomo Frati  3   4 , Ernesto Greco  1 , Francesco Macrina  1 , Paolo De Orchi  1 , Antonino G M Marullo  3
Affiliations

Different Techniques of Surgical Left Atrial Appendage Closure and Their Efficacy: A Systematic Review

Mizar D'Abramo et al. Rev Cardiovasc Med. .

Abstract

Background: Atrial fibrillation has been identified as an independent risk factor for thromboembolic events. Since 1948 different surgical techniques have described the feasibility and the rationale of left atrial surgical appendage closure. The aim of this systematic review is to evaluate the reported patency rates of different surgical techniques.

Methods: This systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two independent investigators searched the PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and OVID® (Wolters Kluwer, Alphen aan den Rijn, Netherlands) to identify relevant studies. Consecutively, a PICO (Population, Intervention, Comparison and Outcomes) strategy assessment of literature was performed to search eventual other relevant studies that may have been ignored.

Results: A total of 42 studies were included in our analysis. The total number of patients who underwent surgical left atrial appendage closure was 5671, and in 61.2% an imaging follow up was performed, mostly with transesophageal echocardiographic evaluation. Success rate for the different techniques was: Clip deployment 98%; Lariat procedure 88%; Surgical amputation 91%; Endocardial suture 74.3%, Epicardial suture 65%; Left atrial appendage closure (LAAC) ligation 60.9%; Stapler technique with excision of left atrial appendage (LAA) 100%; Stapler without excision 70%.

Conclusions: To date, data on surgical left atrial appendage closure are poor and not standardized, even if reported rates are acceptable and comparable to transcatheter procedures. If validated on large-scale non-retrospective and multicentric studies, these promising developments may offer a valuable alternative for patients with atrial fibrillation (AF) and ineligible for oral anticoagulation therapy.

Keywords: LAAC; atrial fibrillation; left atrial appendage; left atrial appendage closure; surgical closure.

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Conflict of interest statement

The authors declare no conflict of interest. Mariangela Peruzzi is serving as Guest Editor of this journal. We declare that Mariangela Peruzzi had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Buddhadeb Dawn.

Figures

Fig. 1.
Fig. 1.
Left atrial appendage classification according to morphologies. (A) LAA Chicken wing shaped. (B) LAA Cactus shaped. (C) LAA Windsock shaped. (D) LAA Cauliflower shaped. (E) Left atrial appendage. LAA, left atrial appendage.
Fig. 2.
Fig. 2.
Surgical left atrial appendage closure classification.
Fig. 3.
Fig. 3.
Surgical techniques of left atrial appendage closure. (A) Endoloop Snaring. (B) Surgical stapler. (C) Epicardial excision. (D) Purse string exclusion.
Fig. 4.
Fig. 4.
PRISMA Chart.
Fig. 5.
Fig. 5.
ROBVIS: Risk-of-bias VISualization. (A) Traffic Light Plot for risk of bias domains. (B) Weighted bar plots of the distribution of risk-of-bias for each domain.
See this image and copyright information in PMC

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