Medium-to-long-term success rate of left atrial appendage closure using endocardial sutures and postoperative anticoagulant strategies - Summary - MDSpire
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Medium-to-long-term success rate of left atrial appendage closure using endocardial sutures and postoperative anticoagulant strategies
To evaluate the efficacy and safety of endocardial suture closure of the left atrial appendage (LAA) during concomitant cardiac surgery in patients with atrial fibrillation (AF).
Approach:
Study Design: A retrospective study involving 50 patients with valvular heart disease and AF who underwent valve surgery, the Cox-Maze IV procedure, and LAA closure using an endocardial suture technique.
Follow-Up: Intraoperative transesophageal echocardiography (TEE) assessed immediate closure, while transthoracic echocardiography and TEE were performed during follow-up.
Key Findings:
Mean follow-up duration was 7.16 ± 1.73 years.
Intraoperative TEE showed no residual LAA stump or to-and-fro flow in any patient.
At follow-up, 90.0% closure success rate was observed, with residual to-and-fro flow detected in 5 patients (10.0%), defined as a closure failure.
Four of the five patients with residual flow developed thrombus within the residual LAA stump, and one experienced an ischemic stroke.
No stroke occurred among patients with imaging-confirmed successful LAA closure.
Interpretation:
Endocardial suture closure demonstrated a high medium-to-long-term imaging success rate.
Limitations:
Limited sample size.
Low event rate.
Conclusion:
Postoperative anticoagulation decisions should remain individualized and guideline-informed.
