Left Atrial Appendage Closure with Clip in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Background: We sought to investigate the safety of using left atrial appendage (LAA) closure with clip devices in patients who underwent off-pump coronary artery bypass grafting and who experienced atrial fibrillation. Methods: We applied LAA clips in 25 patients between November 2018 and May 2025. The mean age was 74 years, and 5 patients were female. All patients underwent off-pump CABG via a heart positioner and stabilizer and an LAA clip (21 with AtriClip and 4 Penditure). The mean number of coronary anastomoses was 4.0. The mean follow-up period was 28.6±17.5 months. Results: There were no complications related to the LAA clips. During the operations, we used a fluorescence imaging system in 13 patients to confirm the closure of the LAA. Moreover, in all 25 patients, postoperative enhanced computed tomography confirmed the occlusion of the LAA. No patient experienced stroke or thromboembolic eventsduring the follow-up period. Conclusions: Left atrial appendage closure with a clip was safely performed in patients undergoing off-pump CABG without harmful effects on the heart or grafts. This surgical option may be effective for stroke prevention in patients undergoing off-pump CABG.