Patient selection and methods of surgical left atrial appendage exclusion

  • Jason W. GreenbergEmail author
  • Richard Lee
  • Dawn S. Hui


The left atrial appendage (LAA) is a major source of thromboembolism, particularly in patients with atrial fibrillation (AF). LAA exclusion has arisen as a method of stroke prophylaxis in high-risk patients who have failed medical management, in whom medical management is contraindicated, and in those undergoing concomitant cardiac surgery. Percutaneous LAA exclusion with devices such as the Watchman has been described extensively in the cardiology literature, but surgical exclusion is less often discussed. Several techniques exist for surgical LAA exclusion, including appendage excision (removal), internal ligation from within the left atrium (LA), and external occlusion without opening the LA. The decision of which surgical technique to employ is dependent upon individual patient characteristics including risk factors, surgical history, and appendage anatomy. This paper discusses patient selection for surgical LAA exclusion and methods of surgical exclusion for the non-cardiac surgery medical practitioner.


Atrial fibrillation Anticoagulation Embolism Thrombosis Stroke 


Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jason W. Greenberg
    • 1
    Email author
  • Richard Lee
    • 2
  • Dawn S. Hui
    • 3
  1. 1.Saint Louis University School of MedicineSaint LouisUSA
  2. 2.Medical College of Georgia at Augusta UniversityAugustaUSA
  3. 3.University of Texas Health Science Center at San AntonioSan AntonioUSA

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