Patient selection and methods of surgical left atrial appendage exclusion

Jason W. Greenberg, Richard Lee, Dawn S. Hui

Research output: Contribution to journalReview article

Abstract

The left atrial appendage (LAA) is a major source of thromboembolism, particularly in patients with atrial fibrillation (AF). LAA exclusion has arisen as a method of stroke prophylaxis in high-risk patients who have failed medical management, in whom medical management is contraindicated, and in those undergoing concomitant cardiac surgery. Percutaneous LAA exclusion with devices such as the Watchman has been described extensively in the cardiology literature, but surgical exclusion is less often discussed. Several techniques exist for surgical LAA exclusion, including appendage excision (removal), internal ligation from within the left atrium (LA), and external occlusion without opening the LA. The decision of which surgical technique to employ is dependent upon individual patient characteristics including risk factors, surgical history, and appendage anatomy. This paper discusses patient selection for surgical LAA exclusion and methods of surgical exclusion for the non-cardiac surgery medical practitioner.

Original languageEnglish (US)
Pages (from-to)209-214
Number of pages6
JournalJournal of Thrombosis and Thrombolysis
Volume48
Issue number2
DOIs
StatePublished - Aug 15 2019

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Embolism
  • Stroke
  • Thrombosis

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

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