• Jeff S Healey, Eugene Crystal, Andre Lamy, Kevin Teoh, Lloyd Semelhago, Stefan H Hohnloser, Irene Cybulsky, Labib Abouzahr, Corey Sawchuck, Sandra Carroll, Carlos Morillo, Peter Kleine, Victor Chu, Eva Lonn, and Stuart J Connolly.
• McMaster University, Hamilton, Ontario, Canada. healeyj@hhsc.ca
• Am. Heart J. 2005 Aug 1;150(2):288-93.

AimThis pilot study assessed the safety and efficacy of left atrial appendage (LAA) occlusion, performed at the time of coronary artery bypass grafting (CABG).Methods And ResultsAt the time of CABG, 77 patients with risk factors for stroke were randomized to LAA occlusion or control. The LAA was occluded using sutures or a stapling device. Completeness of occlusion was assessed with transesophageal echocardiography. There were no significant differences in cardiopulmonary bypass duration, perioperative heart failure, atrial fibrillation, or bleeding between the 2 groups. During surgery, there were 9 appendage tears, all of which were repaired easily with sutures. Among patients having a postoperative transesophageal echocardiography, complete occlusion of the LAA was achieved in 45% (5/11) of cases using sutures and in 72% (24/33) using a stapler, P = .14. The rate of LAA occlusion by individual surgeons increased from 43% (9/21) to 87% (20/23) after performing 4 cases (P = .0001). After a mean follow-up of 13 +/- 7 months, 2.6% of patients had thromboembolic events.ConclusionsLAA occlusion at the time of CABG is safe. The rate of complete occlusion improves, to acceptable levels, with increased experience and the use of a stapling device. A large trial is needed to determine if LAA occlusion prevents stroke.

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