Left atrial appendage closure is a medical procedure, often performed minimally invasively, that involves sealing off the left atrial appendage (LAA), a small sac located within the muscular wall of the left atrium, which is the upper left chamber of the heart. This procedure is primarily undertaken to reduce the risk of stroke and eliminate the necessity for blood-thinning medications. Research indicates that in individuals with atrial fibrillation who do not have valve disease, a significant portion of blood clots that can lead to strokes originate in the LAA.
The specific function of the left atrial appendage remains uncertain. However, closing or removing it does not hinder the heart’s ability to perform its vital functions. In a healthy heart, each heartbeat is characterized by coordinated contractions, allowing blood to flow from the left atrium and LAA into the left ventricle, the bottom left chamber of the heart.
In atrial fibrillation, an irregular heart rhythm, electrical impulses responsible for controlling the heartbeat become disordered. This results in multiple impulses occurring simultaneously and spreading chaotically through the atria. Consequently, the atria do not contract effectively, and blood can accumulate in the LAA and atria, potentially forming clots. These clots, when ejected from the heart, pose a significant risk of causing strokes. Individuals with atrial fibrillation are at a significantly higher risk, three to five times more so, for experiencing strokes compared to the general population.
There are several types of left atrial appendage closure devices designed to prevent blood clots from escaping the LAA into the bloodstream:
If you are at risk of developing blood clots in your left atrium or left atrial appendage, your healthcare provider might suggest a procedure to close off the LAA as an alternative to using blood thinners like warfarin to reduce the risk of stroke associated with atrial fibrillation.
Many individuals have reservations about or dislike taking warfarin due to various reasons, including:
There are other medications, such as dabigatran and rivaroxaban, available for people with atrial fibrillation who do not have heart valve disease. However, some individuals have concerns and encounter issues with these medications, including:
LAA closure is effective in lowering the stroke risk linked to atrial fibrillation, but it does not address the underlying AFib condition itself. This procedure is advantageous for individuals who require heart surgery and have atrial fibrillation as a concurrent condition. Additionally, it proves beneficial for individuals with atrial fibrillation, who do not have any other heart surgery-related issues, and opt for a Maze procedure to manage their atrial fibrillation.
Possible complications associated with left atrial appendage (LAA) closure can include:
Your healthcare provider will perform either a transesophageal echocardiogram (TEE) or a cardiac computed tomography (CT) scan to gather precise dimensions of your left atrial appendage. This is a crucial step as these structures exhibit significant variations among individuals, resembling shapes such as a chicken wing or cauliflower. Additionally, three-dimensional printing may be utilized to aid in selecting the appropriate device and determining its size. The procedure will also involve anesthesia tailored to the specific technique being used.
During surgery to address conditions such as coronary artery disease or valve disease, medical professionals have the option to address the left atrial appendage by either surgically removing it and suturing or stapling the area closed, or by employing a minimally invasive approach using a catheter to insert a specialized device for closure.
For the minimally invasive catheter-based method, the procedure typically involves the following steps:
Throughout the procedure, imaging techniques such as fluoroscopy (real-time X-ray video), transesophageal echo (TEE), or intracardiac ultrasound (ICE) may be used to guide the healthcare provider in accurately placing the closure device.
This approach aims to reduce the risk of blood clots forming in the left atrial appendage and potentially causing stroke or other complications.
Following your surgery or minimally invasive procedure, you may need to spend a night or more in the hospital. Additionally, it might be necessary to undergo a transesophageal echo (TEE) within the first 48 hours post-procedure as part of your follow-up care.
Recovering from LAA closure surgery after another heart procedure varies based on the type of surgery you had:
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