Left Atrial Appendage Exclusion During MIDCAB
Pablo F. Ruda Vega, Marc P. Pelletier, Gregory D. Rushing.
University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
BACKGROUND: Recent trials support more aggressive management of the left atrial appendage during cardiac surgical operations. In our division, minimally invasive coronary bypass, MIDCAB (LIMA to LAD), has become the therapy of choice to treat proximal LAD lesions not suitable for stenting. Elderly patients who are considered for MIDCAB often have a higher risk of bleeding and stroke. We present our initial experience excluding the left atrial appendage during MIDCAB.
METHODS: In 2022 sixty-three patients underwent MIDCAB. Of these seven underwent concomitant left atrial appendage exclusion. Mini left anterior thoracotomy was used in all patients, one patient underwent multi-vessel grafting. Left atrial appendage exclusion was performed thoracoscopically (1), and via direct mini left anterior thoracotomy (6).
RESULTS: The average age was 79 years; there were 4 men and 3 women. The average CHADS2VASC2 score was 5.14, the average HASBLED score was 3.71. Four patients had an established diagnosis of atrial fibrillation. Average follow up was four months; there were no myocardial infarctions, no strokes, and no deaths. All patients had TEE verified complete exclusion of the left atrial appendage.
CONCLUSIONS: Surgical left atrial appendage exclusion is feasible in minimally invasive coronary revascularization. Concomitant left atrial appendage exclusion should be used to expand the indications for hybrid revascularization, especially in the elderly population. 
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