Surgical Exclusion of LAA Does Not Always Result in Complete Occlusion of LAA

Background: Surgical left atrial appendage (LAA) exclusion is often performed as an adjunctive procedure during heart surgery to prevent embolic strokes and/or systemic thromboembolism, regardless of a previous history of atrial fibrillation. Data regarding the success of the newer techniques for LAA occlusion are limited. Objective: To investigate the anatomical variations in residual LAA and the rate of thrombus formation following surgical occlusion of the LAA. Design: Retrospective review. Methods: The authors reviewed clinical data of 350 patients who underwent surgical LAA exclusion in several hospital systems from 2012 until 2022 and also underwent subsequent cardiac CT and/or transesophageal echocardiography (TEE). A residual LAA was defined as a smooth-walled or pectinate-containing outpouching extending out of the left atrial wall. When a residual LAA was identified, it was measured from the left circumflex artery to the deepest part of the pouch. The LAA exclusion was defi more...