title: Complete Obliteration of the Left Atrial Appendage: An Analysis of Epicardial Excision and Novel Pericardial Patch Exclusion.
abstract: OBJECTIVE
  Conventional epicardial excision is believed to be the most effective method of surgically obliterating the left atrial appendage (LAA), although incomplete resection and residual LAA volume may undermine its effectiveness. We sought to compare the impact of conventional epicardial excision with a novel LAA pericardial patch exclusion on residual LAA volume.
  
  
  METHODS
  We performed LAA obliteration using pericardial patch exclusion, followed by conventional epicardial excision, in 27 cadaveric hearts. After each procedure, residual LAA volume was measured by two different techniques and compared with baseline volume. There was no difference in baseline LAA volume between each procedure.
  
  
  RESULTS
  Procedural success was achieved in all hearts. Conventional epicardial excision left a residual LAA volume of 0.95 mL (24%), as compared with pericardial patch exclusion, which left a residual volume of 0.17 mL (4%, P = 0.0001). Further analysis of fixed and fresh hearts showed that reduction of LAA volume was more pronounced in the fresh hearts, suggesting effectiveness in live patients. Neither technique resulted in any significant change in the endocardial shape of the LAA orifice or injury to the circumflex artery.
  
  
  CONCLUSIONS
  Conventional epicardial excision of the LAA results in significantly more residual LAA volume, which may have important implications in persistent stroke risk. Pericardial patch exclusion seems to achieve near-total elimination of the LAA and may be a superior surgical option.
authors: From the *Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario, Canada; and †Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, Ontario, Canada.
authors: Bayan B
authors: BB
authors: Malakouti-Nejad
authors: Eliot J
authors: EJ
authors: Winkler
authors: Marjorie I
authors: MI
authors: Johnson
authors: Jorge
authors: J
authors: Catrip
authors: Katie L
authors: KL
authors: Losenno
authors: Bob B
authors: BB
authors: Kiaii
authors: Michael W A
authors: MW
authors: Chu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D016896:Treatment Outcome