Left Atrial Appendage Closure

What is a Left Atrial Appendage (LAA) Closure?

A left atrial appendage (LAA) closure is a minimally invasive procedure used to close or seal off the left atrial appendage (LAA). The LAA is a small sac found in the muscle wall of the left atrium (upper left chamber of the heart). It does not have an important function, which allows surgeons to remove or seal off the opening to help reduce the risk of stroke in patients who cannot use blood thinners.

Research has demonstrated that most blood clots in the left atrium of patients with atrial fibrillation (who do not have valve disease) often develop in the LAA.

What Do You Need to Know About a Left Atrial Appendage Closure Procedure?

An LAA closure is typically recommended when someone has atrial fibrillation that is not related to valve disease and is at risk for a blood clot and stroke. An LAA closure reduces the risk of stroke in people with atrial fibrillation. It is beneficial for people who require surgery and have atrial fibrillation. LAA closure does not treat atrial fibrillation, it simply reduces the risk of developing blood clots and having a stroke.

The procedure is performed under general anesthesia and consists of inserting a catheter through a vein near the groin area. The catheter is advanced into the right atrium where a hole will be cut between the two chambers. The catheter will be pushed through the hole and into the left atrial appendage. A device is then placed into the left atrial appendage to seal off the opening and prevent it from releasing any blood clots. After about 45 days, a small layer of tissue will grow around the device, preventing any blood clots from entering the bloodstream.

Who Receives a Left Atrial Appendage Closure?

People who are at risk of developing blood clots in their left atrial appendage may be recommended for LAA closure surgery. Specifically, people with atrial fibrillation (not caused by a heart valve problem) who are at an increased risk for stroke but cannot take blood thinners may be recommended for LAA closure surgery. This type of surgery provides an alternative for taking blood thinners, as some people have concerns with taking certain blood thinners due to adverse side effects, or if they are at risk of falling or bleeding.

What Are the Risks with a Left Atrial Appendage Closure?

Although uncommon, complications and risks are possible with LAA closure surgery. Potential complications include:

  • Blood clots around the device
  • Bleeding
  • Negative reaction to the anesthesia
  • Pericardial effusion (fluid buildup in the membrane surrounding the heart)
  • Chest pain
  • Abnormal heart rhythm
  • Cardiac arrest
  • Infection

What Happens After the Procedure?

After the procedure there are a few things that may be expected, including:

  • Staying over night for the procedure (longer if it was a more invasive surgery)
  • A transesophageal echo (TEE) within the first 48 hours of the procedure
  • You will have a follow-up appointment 45 days post-surgery to determine if there was a complete occlusion of the left atrial appendage. If a complete occlusion was demonstrated, your anti-coagulant medication will be stopped.
  • Once the LAA is sealed off for good, it is recommended to be on a low dosage of aspirin, indefinitely