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J Thorac Cardiovasc Surg 2007;133:174-181
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Impact of left atrial appendage exclusion on left atrial function

Keiji Kamohara, MD^a, Zoran B. Popovi, MD^b, Masao Daimon, MD^b, Maureen Martin, RDCS^b, Yoshio Ootaki, MD, PhD^a, Masatoshi Akiyama, MD, PhD^a, Firas Zahr, MD^a, Faruk Cingoz, MD^a, Chiyo Ootaki, MD^a, Michael W. Kopcak, Jr, BA^a, Raymond Dessoffy, AA^a, Jenny Liu, BA^a, James D. Thomas, MD^b, A. Marc Gillinov, MD^c, Kiyotaka Fukamachi, MD, PhD^a,_*

^a Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic, Cleveland Ohio
^b Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland Ohio
^c Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland Ohio.

Received for publication May 4, 2006; revisions received August 10, 2006; accepted for publication August 25, 2006.

^_* Address for reprints: Kiyotaka Fukamachi, MD, PhD, Department of Biomedical Engineering/ND20, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195. (Email: fukamak{at}ccf.org).

OBJECTIVES: We sought to investigate the short-term and midterm effects of left atrial appendage exclusion on left atrial function. Left atrial appendage exclusion is considered a possible therapeutic option for stroke prevention in patients with atrial fibrillation. Favorable outcomes have encouraged widespread use of left atrial appendage exclusion for cardiac surgical patients—even for patients in sinus rhythm who have stroke risk factors; however, the chronic effects on left atrial function of left atrial appendage exclusion are unclear.

METHODS: Nineteen mongrel dogs (29.7 ± 5.2 kg) in sinus rhythm were studied. The Doppler signals from the pulmonary venous flow, transmitral flow, and tissue Doppler imaging of mitral annular motion were obtained before and after left atrial appendage exclusion. Dogs were evaluated in the same manner at 7 days (n = 2), 30 days (n = 7), or 90 days (n = 10) after left atrial appendage exclusion.

RESULTS: Except for a significant increase in early diastolic transmitral flow velocity after left atrial appendage exclusion (P = .01), no significant differences were found in any parameters related to the transmitral flow and tissue Doppler imaging measurements throughout follow-up. The systolic components of pulmonary venous flow at follow-up revealed a significant reduction relative to baseline (peak systolic velocity P < .0001, systolic velocity-time integral P < .0001), despite the lack of significant changes in left atrial pressure, left ventricular volume, and stroke volume.

CONCLUSION: Left atrial appendage exclusion may affect left atrial reservoir function in the short-term and midterm periods. Further long-term studies with more clinically relevant models are needed.