Exclusion of the left atrial appendage: an effective method

Objective The left atrial appendage (LAA) is a frequent site of thrombus formation in patients with mitral valve disease, especially in those with atrial fibrillation (AF). Several surgical techniques of LAA closure are used with varying success rates. An incomplete LAA closure becomes a nidus for thrombus formation and is a potential source of embolization. To combat this difficulty we used a novel technique to effectively and completely exclude the LAA during mitral valve surgery. Methods Twenty-eight patients with mitral valve disease and in AF with or without a left atrium (LA)/LAA clot were enrolled in this prospective study. We used fresh autologous pericardial patch to occlude the LAA orifice. All the patients were reviewed at 3 months for any history of thromboembolic events, and a transoesophageal echocardiography (TEE) was also done to look for the completeness of repair. Results All the patients had an uneventful recovery. Our technique resulted in complete exclusion of the LAA from LA, which was confirmed by TEE at 3 months post-operatively and showed no residual connection between the LA and LAA, no fresh LA clot, and a good valve function as well. There was no history of any thromboembolic phenomena in any patient. Conclusion In patients with mitral valve disease in AF with/without the presence of LA/LAA clot, using an autologous pericardial patch to exclude the LAA is a relatively simple procedure and results in complete exclusion.