Left atrial appendage elimination techniques: stapled excision versus internal suture obliteration

Abstract

Background: This study was conducted to compare the efficacy and safety of left atrium appendage [(LA)A] elimination using stapled excision with those using internal suture obliteration. Methods: In all, 158 patients with atrial fibrillation who underwent surgical elimination of the LAA during cardiac surgery and later underwent postoperative computed tomography (CT) were enrolled. Of these, 102 patients underwent stapled excision (SE group), and 56 underwent internal suture obliteration (IO group). The efficacy endpoint was LAA excision failure, including a remnant LAA (>1 cm) or communication between the LA and LAA. The safety endpoint was bleeding from the elimination site. The CT was performed at a median of 12.8 months (interquartile range, 0.3-39.9) after surgery. Results: The efficacy endpoint was observed in 5 (4.9%) and 9 patients (16.1%) in the SE and IO groups, respectively (P=0.036). In the SE group, a remnant LAA was found in 5 patients and extravasation of the dye was not observed. In the IO group, a remnant LAA, a communication between the LA and LAA, and both findings were observed in 1, 6, and 2 patients, respectively. The safety endpoint occurred in 12 (11.8%) and 0 patients (0%) in the SE and IO groups, respectively (P=0.009). Conclusions: Stapled excision of the LAA was associated with a lower rate of LAA elimination failure compared to internal suture obliteration. However, care should be taken to prevent staple-related bleeding.