Surgical Closure of the Left Atrial Appendage. Basal Considerations before attempting with Occluder Devices

Despite a lot of publications in favor of left atrial appendage occlusion, basal considerations regarding the closure of the left atrial appendage seem to be missed. Surgical closure of the left atrial appendage is the most direct method to analyze all the most common arising contingencies. The most effective method to achieve a successful left atrial appendage closure is surgical “cut-and-sew” with total removal of the left atrial appendage. Surgical suture exclusion and stapler exclusion show 23% and 0% of success rate, respectively. A high percentage of patients with suture exclusion have persistent flow into the appendage documented by color Doppler (60%), and a high percentage of those with stapler exclusion exhibit a persistent left atrial appendage stump >1 cm (58%). Incomplete closure of the left atrial appendage is an independent predictor of stroke or systemic embolism, and the stroke risk is 5-fold higher than expected. All these data may have important implications for cardiologists regarding left atrial appendages occluder devices.