Atrial fibrillation (AFib) makes your heart beat out of rhythm, which puts you at higher risk for a stroke from blood clots. Left atrial appendage (LAA) percutaneous closure surgery lowers your stroke risk by lowering the risk of blood clots forming in part of your heart.
Surgery is just one treatment for AFib, along with medication and lifestyle changes. Your doctor will help you choose a treatment based on your health, how well medicine has worked for you, and how much AFib affects your life.
Why Would I Need Left Atrial Appendage Percutaneous Closure?
AFib is a type of irregular heart rhythm, or arrhythmia. A problem with the electrical signals in your heart makes the two upper chambers (atria) beat out of sync with the two lower chambers (ventricles). Your heart beats in the wrong rhythm and can sometimes beat too slowly or too quickly.
AFib prevents your heart from pushing blood out to your body as quickly as usual. Blood flow can slow so much that it pools inside your heart and forms clumps called clots. In people with AFib, most blood clots start in a small sac called the left atrial appendage (LAA) in the top left part of their heart.
Once a clot forms, your heart can pump it out of the LAA and into your bloodstream. If the clot reaches your brain, it could block a blood vessel there and cause a stroke. People with AFib are up to five times more likely to have a stroke than those without AFib.
The main way to prevent a stroke is to take blood thinners, but one in three people with AFib don't get enough protection from these medicines alone. Blood thinners can also cause serious bleeding and other side effects.
Your doctor might recommend LAA percutaneous closure surgery if you're at risk of getting clots in your left atrial appendage and you can't take blood thinners like warfarin (Coumadin), or you don't want to take these medicines.
How Does Left Atrial Appendage Percutaneous Closure Work?
LAA closure surgery seals off the left atrial appendage so that blood can't flow into that part of your heart. When blood doesn't flow into the LAA, clots can't form there. Any clots that do form can't leave your heart and get out into your bloodstream.
This surgery won't affect your heart's function. The heart can still pump normally with a closed LAA.
How Is Left Atrial Appendage Percutaneous Closure Done?
While you are asleep, your cardiologist will place a very small device into your heart to seal off the LAA. There are a few different ways to do this surgery. Your doctor will recommend the method that best fits your situation.
Close the opening with a loop. The Lariat procedure gets its name from a lasso, which is basically what it does. The cardiologist puts a thin, flexible tube called a catheter into a blood vessel and threads it up to your heart. Then they tie a loop stitch at the bottom of your LAA to seal it off from the rest of your heart.
Block the opening. WATCHMAN and Amplatzer are devices that block the entrance to the LAA so that blood can't get in and clots can't get out. The two devices are shaped differently but work in a similar way.
First, the cardiologist puts a catheter into a vein in your groin and threads it up to the upper right chamber of your heart. Then they make a small hole between your heart's two chambers to put the catheter into your left atrium. They push the device through the catheter into your left atrium.
Once in place, the device expands inside your LAA like a tiny umbrella and stays there. In about 45 days, a thin layer of tissue grows over the implant. That tissue seals your left atrial appendage closed and prevents any blood clots that form from getting into your blood.
Surgical Options
Close the opening with a clip. The AtriClip seals off your LAA to prevent blood from getting in or out. First your surgeon makes a small opening on the left side of your chest. A camera and catheter go into the hole. The camera lets your surgeon watch the procedure on a screen.
The doctor places the AtriClip around the outside of your LAA and closes it to stop the blood flow. Stitches keep the opening closed.
Open-heart surgery. Sometimes the surgeon has to remove the whole LAA. This may be done at the same time as another type of surgery, such as coronary bypass or valve surgery.
What Happens After Left Atrial Appendage Percutaneous Closure?
Within a day or two after your procedure, you'll get a test called a transesophageal echocardiogram (TEE). A long, thin tube with an ultrasound device attached to the end goes down your throat. It lets your doctor see your heart.
The TEE can show whether the opening in your LAA is fully closed and if there are any clots inside. If the LAA is closed, you may be able to stop taking blood thinners.
Possible Risks
This surgery has a success rate of over 90%. The risks depend on the type of procedure you have and your health in general.
The most common complications from LAA percutaneous closure surgery are:
- A problem with the device
- Bleeding
- Chest pain
- Infection
- Fluid buildup in the sac around the heart, called pericardial effusion
- Fluid in the space around the heart, called cardiac tamponade
You'll be less likely to have complications if you go to a medical center that does a lot of these procedures and you have an experienced cardiologist or surgeon.
Who Shouldn't Get Left Atrial Appendage Percutaneous Closure?
You don't need this surgery if you're at low risk for stroke. Your doctor also might not recommend this procedure if you have:
- Heart valve disease such as mitral stenosis
- A blood clot in your left atrium
- An infection
- A hole in the wall that divides the two atria (atrial septal defect)
- An artificial heart valve
Having an LAA that's a different size than usual or that's in the wrong place could make this procedure hard to do. Your doctor may do a computed tomography (CT) scan to check your LAA before your procedure.
What Should I Expect After Left Atrial Appendage Percutaneous Closure?
LAA closure procedures lower your risk for stroke by preventing blood clots from forming and leaving the left atrium of your heart. It doesn't treat AFib itself. Afterward, you may still need to take medicine or use other treatments to keep your heart in a normal rhythm.
It takes about 45 days for tissue to grow around the device and seal off your LAA. You'll take blood thinners during that time to prevent clots.
You may need to stay on aspirin long-term to prevent clots from forming in other parts of your heart or blood vessels.
Making the Decision to Have Left Atrial Appendage Percutaneous Closure
Your doctor will go over the risks and benefits of LAA percutaneous closure with you. Make sure you know how this procedure might help you and what side effects it could cause. Also ask your doctor what other treatments there are, if any.