Effectiveness of surgical left atrial appendage closure during minimally invasive mitral valve surgery

BACKGROUND Left atrial appendage closure (LAAC) reduces the risk of stroke in patients with atrial fibrillation. It can be performed surgically from the inside of the left atrium or from the outside. Stapling or clipping devices can also be used from the outside. Despite providing an excellent interior view of the appendage, those techniques cannot be implemented during minimally invasive mitral valve surgery conducted through right-sided minithoracotomy. AIMS This study aimed to assess the effectiveness of surgical closure of the left atrial appendage from the inside during minimally invasive mitral valve surgery. METHODS A total of 50 patients with mitral valve disease and atrial fibrillation who underwent minimally invasive mitral valve surgery and LAAC between 2012 and 2017 were included in this study. The appendage was closed from the inside using a continuous suture. After a median follow-up of 1.6 years after surgery, 19 patients were examined by transthoracic and transesophageal echocardiography (TEE). Transesophageal echocardiography was performed to assess whether the appendage had been effectively closed. When any leakage was suspected, cardiac computed tomography was performed. RESULTS In 19 patients, TEE was performed at 0.5 to 5 years after the surgery. A single patient did not tolerate TEE, and minimal leakage was suspected in 2 patients. All 3 individuals underwent computed tomography examination, which confirmed leakage in a single patient. CONCLUSIONS Surgical LAAC during minimally invasive mitral valve surgery through right minithoracotomy is an effective technique that provides durable results.