ArticleStructural heart : the journal of the Heart Team2025
Postoperative Transesophageal Echocardiographic Evaluation of Surgical Left Atrial Appendage Exclusion: Characterization and Predictors of Success.
Article in Structural heart : the journal of the Heart Team, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Incomplete Left Atrial Appendage Closure: How to Address the (Knowledge) Gap?Structural heart : the journal of the Heart Team · 2025Article
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6 authors.
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Abstract
Background: Mounting evidence suggests surgical left atrial appendage (LAA) exclusion reduces stroke risk in patients with atrial fibrillation. Prior older research suggests that LAA exclusion is often incomplete, but few transesophageal echocardiogram (TEE) data exist evaluating LAA remnants. Methods: We analyzed 121 patients with an available postoperative TEE who underwent LAA exclusion by surgical excision (SE), AtriClip occlusion (AO), or Tiger Paw occlusion (TO). TEE images were assessed for LAA remnant depths, presence of flow into remnant, and visible suture, thrombus, or pectinate. Successful LAA exclusion was defined as a remnant with depth past LAA ostium <1 cm in all available imaging angles. Results: Left atrial appendage exclusion was successful in 99/121 (82%) patients. Success varied numerically but not statistically by technique; 73/85 (86%), 22/29 (76%), 4/7 (57%) in the SE, AO, and TO groups, respectively. SE group had similar mean and max (cm) remnant depths (0.56 ± 0.32 and 0.65 ± 0.38) compared to the AO group (0.68 ± 0.38 and 0.81 ± 0.49) and TO group (0.69 ± 0.30 and 0.83 ± 0.40). Flow into LAA remnant was seen in 4.4% (SE), 15.0% (AO), and 20.0% (TO). Residual pectinate was seen in 18.8% (SE), 13.8% (AO), and 14.3% (TO); 8% in SE group had visible suture. Thrombus was seen in 2 cases within the SE group. In multivariable models, diabetes and heart failure predicted max LAA depth. Conclusions: Postoperative TEE examination of LAA remnants revealed a relatively high failure rate by current standards. More data are needed to evaluate the clinical relevance of LAA remnant characteristics.
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