title: Intraoperative Assessment of Left Atrial Diverticulum and Remnant Stump after Left Atrial Appendage Epicardial Occlusion.
abstract: OBJECTIVE
  Epicardial left atrial appendage (LAA) closure with use of occluder is an emerging technique. Absence of remnant LAA stump is major criterion of successful obliteration. The aim of study was to assess early success rate of epicardial LAA closure.
  
  
  METHODS
  Fifteen patients with persistent AF and coronary artery disease underwent off-pump coronary revascularization with concomitant ablation and LAA epicardial occlusion with use of two types of occluders. Before incision and after appendage closure, TEE was performed to assess the LAA anatomy, diameter of left atrial ridge, and remnant LAA stump after occlusion.
  
  
  RESULTS
  In 80% (12) of patients, formation of a left atrial diverticulum was observed with the left atrial ridge forming the superior boundary. In 5 patients (33%), a minimal remnant LAA stump was found, none exceeding 1 cm (average length: 1.5 ± 2.3 mm). In all patients, blood flow in LAA cavity distal to the occluder was absent. There was no significant difference in LAA type, average left atrial diameter, LAA orifice, LAA length, left atrial ridge, or size of occluder used between patients with and without a remnant LAA stump. Occurrence of a remnant LAA stump correlated significantly with unfavorable anatomy (LAA orifice < 20 mm and LA ridge > 5 mm; r = 0.5774, P = 0.02).
  
  
  CONCLUSIONS
  The early success of epicardial LAA occlusion is not dependent on LAA morphologic type or occluder used. A minimal remnant LAA stump not exceeding 1 cm in length without distal blood flow was observed in one-third of the cases.
authors.affiliation: Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland. grzegorz.suwalski@wp.pl.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Suwalski
authors.affiliation: Department of Cardiac Surgery, St. Joseph's Hospital, St. Paul, Minnesota.
authors.forename: Robert
authors.initials: R
authors.lastname: Emery
authors.affiliation: Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Gryszko
authors.affiliation: Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Kaczejko
authors.affiliation: Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Mroz
authors.affiliation: Department of Cardiology, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Skrobowski
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D004240:Diverticulum / Q000000981:diagnostic imaging* / Q000601:surgery*; D004452:Echocardiography / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055989:Septal Occluder Device; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: atrial fibrillation; epicardial occlusion; left atrial appendage function