Medium-to-Long-Term Success Rate of Left Atrial Appendage Closure Using Endocardial Sutures and Postoperative Anticoagulant Strategies

Background Surgical endocardial closure of the left atrial appendage (LAA) is reported to reduce the risk of stroke in patients with atrial fibrillation (AF). This retrospective study assessed the efficacy and safety of endocardial suture obliteration with medium-to-long-term follow-up. Methods A total of 50 patients with valvular diseases and AF, treated from 2013 to 2018, were included in the analysis. All underwent heart valve surgery, the Cox-Maze IV procedure, and LAA closure using the endocardial suture obliteration technique. Intraoperative transesophageal echocardiography (TEE) was performed to assess the LAA closure outcomes. Closure failure was defined as a remnant LAA (> 1 cm) or persistent flow between the left atrium (LA) and LAA. Patients were followed up for an average of 7.16 ± 1.73 years, with transthoracic echocardiography (TTE) and TEE used to assess the results. Results Intraoperative TEE revealed no remnants of the LAA or persistent flow in any patient post-closure. None of those monitored postoperatively with TEE exhibited a remnant LAA > 1 cm; however, 5 (10%) patients had persistent flow between the LA and LAA. Of these five patients with closure failure, four (75%) presented with thrombus in the LAA stump, and one experienced a stroke event. Conclusion Our center has widely adopted the intraoperative closure of the LAA due to its simplicity, minimal bleeding risk, cost-effectiveness, and high success rate. For patients with confirmed LAA closure based on TEE evaluation, continued use of anticoagulant drugs may not be necessary.