Epicardial-placed occlusion devices achieved a 93.8% successful left atrial appendage exclusion rate on postoperative CT, compared to 80% for primary surgical closure.
Observational (n=79)
Does an epicardial-placed occlusion device improve successful LAA exclusion rates compared to primary surgical closure in patients undergoing surgical LAA closure?
Epicardial-placed occlusion devices trend toward higher successful LAA exclusion rates compared to primary surgical closure, and noninvasive cardiac CT is a useful modality for evaluating these technical outcomes.
Absolute Event Rate: 93.8% vs 80%
Background Closure of the left atrial appendage in patients with atrial fibrillation significantly decreases the rate of future complications. Exclusion success is typically evaluated via transesophageal echocardiography, an invasive procedure typically requiring patient sedation. We investigated left atrial appendage (LAA) exclusion rates postoperatively utilizing cardiac computed tomography (CT). Methods We conducted a retrospective review of patients who underwent surgical LAA closure. Closure techniques were compared utilizing postoperative cardiac CT. Successful closure was defined by remnant pouch <1 cm and absence of distal contrast flow. Rates of postoperative reintervention, thromboembolic events, and anticoagulation usage were also assessed. Results Seventy-nine patients underwent surgical LAA closure and completed postoperative cardiac CT. Successful exclusion was seen in 60 of 64 patients (93.8%) receiving an epicardial-placed occlusion device and 12 of 15 (80%) undergoing primary surgical closure (2/2, 100%, pericardial patch; 10/13, 76.9%, internal suture ligation). Four exclusion failures of epicardial-placed occlusion devices were characterized by residual stump. Three failures with internal suture ligation were described as patent left atrial appendage orifice. Conclusions Primary surgical closure trended toward a higher imaging failure rate compared to an epicardial occlusion device. Noninvasive CT imaging was useful to evaluate successful LAA closure. The ability to identify exclusion failure allows surgeons to refine operative techniques.
Hocking et al. (Fri,) conducted a observational in Atrial fibrillation (n=79). Epicardial-placed occlusion device vs. Primary surgical closure was evaluated on Successful closure defined by remnant pouch <1 cm and absence of distal contrast flow on CT. Epicardial-placed occlusion devices achieved a 93.8% successful left atrial appendage exclusion rate on postoperative CT, compared to 80% for primary surgical closure.