atrial appendage closed often?

[windsurfer]

I'm curious if closing the left atrial appendage is very common during an AVR. Have most here on the list had it done? My cardiologist suggested it was a good thing to do even if don't have AFib yet since if I ever get Afib, that is where many clots form. If nature put the apendage there, does it have some role? Is there any downside to this procedure? I'll only need an AVR so this would be an extra thing done while I'm opened up. Taking blood thinners is difficult for me due to a malabsorption disease - celiac.

Thanks ahead of time for the feedback,

Bob

 

[RCB]

Here is one study

Here is one study

Windsurfer,
You may want to take a look at this study, but keep in mind that
the operative word in this study is "may". I had mine removed as a matter
of SOP. I have chronic a-fib without much chance for NSR, so my biggest worry is a stroke, so I am content with removal. Still afib remains a puzzle.
Please read this with a "grain-of-salt"(in a figurative sence only):

http://www.chestjournal.org/cgi/content/full/124/6/2356

 

[bvdr]

Try a search on this forum. A while back I posted a link under the the heading: Left atrial appendage/blood clots.

I had mine sewed down when I had my MVR.

 

[windsurfer]

good article

good article

Windsurfer,
You may want to take a look at this study, but keep in mind that
the operative word in this study is "may". I had mine removed as a matter
of SOP. I have chronic a-fib without much chance for NSR, so my biggest worry is a stroke, so I am content with removal. Still afib remains a puzzle.
Please read this with a "grain-of-salt"(in a figurative sence only):

http://www.chestjournal.org/cgi/content/full/124/6/2356

Thank you for the reference - sounds like it is not a good idea when you don't have AF and even if you do, it should be carefully considered - risks/benefits.
Bob

 

[windsurfer]

AF & pre-emptive LAA ligation

AF & pre-emptive LAA ligation

If I'm reading this correctly, it looks like the Cleveland Clinic (CCF) does pre-emptive left atrial appendage (LAA) removal even if don't have atrial fibrillation (AF). Perhaps most surgeons will follow the CCF lead and remove the LAA even when don't have AF.
http://www.clevelandclinic.org/hear...ardiacconsult/2003/winter/atrialappendage.htm
,...
?For several years, we?ve removed the left atrial appendage and performed a Maze procedure to restore sinus rhythm in those with preexisting AF who required heart surgery for other reasons,? says Dr. Gillinov.

Heart Center surgeons have also been ligating the appendage for selected patients without AF but who face it as a likely post-surgical complication; this includes those having mitral valve repair. But now the Heart Center is broadening its pre-emptive approach by including the procedure in many open-heart cases. It expects this new policy to have a positive impact, both short-term and long.

In the short term, ablating the LAA should reduce post-surgical complications for the 30%-40% of patients who develop AF in the first week after heart surgery. ?It should greatly simplify postoperative care, decreasing the risk of stroke, ...."

Bob again -
However, other research suggests that the LAA may have a useful role, so I guess not all surgeons will do it pre-emptively. See the following links about atrial natriuretic peptide (ANP) and its regulatory role.

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12086211&dopt=Abstract

http://www.cvphysiology.com/Blood Pressure/BP017.htm

Bob

 

[RCB]

Breaking News on LAA- This just in!

Breaking News on LAA- This just in!

If I'm reading this correctly, it looks like the Cleveland Clinic (CCF) does pre-emptive left atrial appendage (LAA) removal even if don't have atrial fibrillation (AF). Perhaps most surgeons will follow the CCF lead and remove the LAA even when don't have AF.
http://www.clevelandclinic.org/hear...ardiacconsult/2003/winter/atrialappendage.htm
,...
?For several years, we?ve removed the left atrial appendage and performed a Maze procedure to restore sinus rhythm in those with preexisting AF who required heart surgery for other reasons,? says Dr. Gillinov.

Heart Center surgeons have also been ligating the appendage for selected patients without AF but who face it as a likely post-surgical complication; this includes those having mitral valve repair. But now the Heart Center is broadening its pre-emptive approach by including the procedure in many open-heart cases. It expects this new policy to have a positive impact, both short-term and long.

In the short term, ablating the LAA should reduce post-surgical complications for the 30%-40% of patients who develop AF in the first week after heart surgery. ?It should greatly simplify postoperative care, decreasing the risk of stroke, ...."

Bob again -
However, other research suggests that the LAA may have a useful role, so I guess not all surgeons will do it pre-emptively. See the following links about atrial natriuretic peptide (ANP) and its regulatory role.

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12086211&dopt=Abstract

http://www.cvphysiology.com/Blood Pressure/BP017.htm

Bob

Dr. McCarthy speaks!

http://www.mddietofutah.com/maze/messages/1471.html

Maybe, it was my age. Maybe, it was my 4th surgery. Maybe, is was my a-fib- but I did have more problems with edema on my last surgery when they removed my LAA at CC. One more stinking thing to worry about!

 

[windsurfer]

I kept my LAA.

I kept my LAA.

Dr. McCarthy speaks!

http://www.mddietofutah.com/maze/messages/1471.html

Maybe, it was my age. Maybe, it was my 4th surgery. Maybe, is was my a-fib- but I did have more problems with edema on my last surgery when they removed my LAA at CC. One more stinking thing to worry about!

Very interesting article. After discussing it with my surgeon, Dr. Kron, (UVA) I decided to keep my LAA. Just had the surgery Thursday, Oct. 20th, released from hospital the following Monday and am recovering at home. So far no AF - it has gone much better than I expected. I'll know more about the surgery in 3 weeks when I see Dr. Kron for follow-up. He is a top surgeon, has done over 200 Ross's so I felt quite safe with him and it has gone very well so far.
Thanks for your references,
Bob