The Strengths and Weaknesses of Left Atrial Appendage Ligation or Exclusion (LARIAT, AtriaClip, Surgical Suture)

Randall J Lee; Thorsten Hanke

doi:10.1016/j.iccl.2022.01.001

The Strengths and Weaknesses of Left Atrial Appendage Ligation or Exclusion (LARIAT, AtriaClip, Surgical Suture)

Interv Cardiol Clin. 2022 Apr;11(2):205-217. doi: 10.1016/j.iccl.2022.01.001. Epub 2022 Mar 11.

Authors

Randall J Lee¹, Thorsten Hanke²

Affiliations

¹ Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, Box 1354, San Francisco, CA 94143, USA. Electronic address: Randall.Lee@ucsf.edu.
² Department of Cardiovascular Surgery, ASKLEPIOS Klinikum Harburg, Abteilung Herzchirurgie, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany.

PMID: 35361465
DOI: 10.1016/j.iccl.2022.01.001

Abstract

Left atrial appendage (LAA) epicardial exclusion has been associated with addressing 2 potential deleterious consequences attributed to the LAA, namely, thrombus formation and an arrhythmogenic contributor in advanced forms of atrial fibrillation. With more than 60 years of history, the surgical exclusion of the LAA has been firmly established. Numerous approaches have been used for surgical LAA exclusion including surgical resections, suture ligation, cutting and non-cutting staples, and surgical clips. Additionally, a percutaneous epicardial LAA ligation approach has been developed. A discussion of the various epicardial LAA exclusion approaches and their efficacy will be discussed, along with the salient beneficial affects on LAA thrombus formation, LAA electrical isolation and neuroendocrine homeostasis.

Keywords: AtriClip; Epicardial LAA exclusion; LARIAT; Surgical LAA closure; Suture.

Publication types

Review

MeSH terms

Atrial Appendage* / surgery
Atrial Fibrillation* / complications
Humans
Ligation
Sutures