Objective:

To evaluate the impact of preoperative left atrial appendage (LAA) thrombus on intraoperative management, postoperative complications, and clinical outcomes in atrial fibrillation (AF) patients undergoing epicardial LAA closure, specifically addressing the safety and efficacy in this subset of patients.

Key Findings:

• No intraoperative strokes or deaths occurred in either group.
• Early postoperative complication rates were low and not significantly different between groups.
• Thromboembolic event rates were comparable: 1.0 vs. 2.3 per 100 patient-years for No-Thrombus and Thrombus groups, respectively, with no significant difference.
• All-cause mortality was 0.3 vs. 0.0 per 100 patient-years for No-Thrombus and Thrombus groups, respectively, with no significant difference.
• Thrombi confined to the LAA tip (Type I) were associated with favorable outcomes.

Interpretation:

Epicardial LAA closure is a feasible and safe option for stroke prevention in select AF patients with LAA thrombi, as it does not increase perioperative risk or compromise long-term outcomes, suggesting a need for revised clinical guidelines.

Limitations:

• Retrospective design may introduce selection bias, potentially affecting the reliability of outcomes.
• Small sample size in the Thrombus Group limits generalizability of findings to a broader population.
• Lack of long-term follow-up data beyond the study period restricts understanding of long-term outcomes.

Conclusion:

Epicardial LAA closure can be safely performed in some AF patients with LAA thrombi who cannot tolerate anticoagulation, providing an alternative for stroke prevention without increased risk, warranting further investigation.