Objective: To demonstrate a simplified technique for ligation of the left atrial appendage (LAA) via limited access
Methods: Ligation of the LAA is accomplished via left mini-thoracotomy following the mini-maze procedure. A combination of endo-loop occlusion with direct purse-string suturing is performed at the base of the LAA. The LAA is opened and decompressed to reduce/eliminate the possibility of recannalization. Corroboration of complete elimination of the LAA is obtained by transesophageal echocardiography.
Results: Twelve patients underwent ligation of the LAA without any complications. This technique has also been employed to eliminate the LAA in over 500 patients in an open chest setting.
Conclusions
1.
Exclusion of the LAA is safe compared to stapling devices.
2.
Placement of the endo-loop and supplementary suture is precise. It does not depend on the angle of penetration of a device maximizing the amount of tissue excluded
3.
Decompression of the LAA allows for the formation of scar tissue eliminating the possibility of recannalization.