Epicardial surgical ligation of the left atrial appendage is safe, reproducible, and effective by transesophageal echocardiographic follow-up.

Objective: The left atrial appendage (LAA) is the source of 90% of thrombi in patients with atrial fibrillation. Our double LAA ligation (LLAA) technique was shown to be 96% successful in a small study. However, the outcomes of these patients have yet to be compared with a set of nonligated patients.

Safe and complete exclusion of the left atrial appendage: a simple epicardial approach.

A standardized technique to permanently exclude the left atrial appendage during cardiac surgical procedures to potentially prevent stroke has never been established. We describe a simplified technique using a combination of endoloop occlusion with direct purse-string suturing supported with multiple teflon pledgets placed epicardially at the base of the appendage. The left atrial appendage is subsequently opened and decompressed to facilitate contraction and scarring, reducing or eliminating the possibility of recannalization.