Document Detail


The left atrial appendage: our most lethal human attachment! Surgical implications.
MedLine Citation:
PMID:  10856866     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To prevent death from atrial fibrillation, a cardiac disease which kills by producing emboli. Atrial fibrillation causes about 25% of strokes and increases stroke rate by five times. Over 90% of these embolic strokes are from clots originating in the left atrial appendage. This study addresses the surgical feasibility of removing the appendage to prevent future deaths in two subcategories of patients. (1) Prophylactic removal during open-heart surgery to study its safety. Theoretically, as these patients age and some develop atrial fibrillation, protection from embolic strokes would already be present. (2) Therapeutic removal in chronic atrial fibrillation patients by means of a thorascopic approach. Its technical feasibility is demonstrated. Its actual stroke prevention potential awaits large studies. METHODS: Appendectomy has been evaluated three ways. (1) Experimentally, thorascopic appendage removal was performed on 20 goats with endoscopic approach. Late studies showed a cleanly healed atrial closure after stapling, and no puckering of tissue as seen with the purse-string approach. (2) Safety of human appendectomy was demonstrated in 437 patients (1995-1997). Routine appendectomy was performed during open-heart surgery. Forty-three appendages were stapled, 391 sutured off. (3) Thorascopic appendectomy in seven patients with chronic atrial fibrillation has been successfully accomplished as an isolated surgical procedure. Stapling or suture closure provides a much cleaner, non-puckered suture line than a purse string. RESULTS: In prophylactic removal, no acute bleeding occurred. No late problems have been identified. Endoscopic removal of the appendage has been successful in seven atrial fibrillation patients. CONCLUSIONS: The left atrial appendage is a lethal source of emboli in atrial fibrillation patients. As patients age and often develop atrial fibrillation, prophylactic appendage removal whenever the chest is open is suggested as a method to prevent future strokes. In chronic atrial fibrillation patients, appendectomy can be done with a mini-thorascopic approach. Further studies are planned to demonstrate the effectiveness of appendectomy in preventing strokes in the chronic fibrillating patients.
Authors:
W D Johnson; A K Ganjoo; C D Stone; R C Srivyas; M Howard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  17     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2000-08-31     Completed Date:  2000-08-31     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  718-22     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, St. Francis Hospital, 3300 South 16th Street, Milwaukee, WI 53215, USA. life@johnsonheartcare.com
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MeSH Terms
Descriptor/Qualifier:
Animals
Atrial Appendage / surgery*,  ultrasonography
Atrial Fibrillation / mortality,  prevention & control*
Cardiac Surgical Procedures / methods*
Clinical Trials as Topic
Disease Models, Animal
Echocardiography, Transesophageal
Female
Goats
Humans
Male
Prognosis
Sensitivity and Specificity
Survival Analysis
Thoracoscopy / methods*
Thromboembolism / mortality,  prevention & control*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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