Mitral Valve Repair - Management of Left Atrial Appendage

Author: David Yang, MD; Edward Verrier, MD
Institution: University of Washington
Date Reviewed: March 2014
Learning Domain: Adult Cardiac Surgery
Learning Objective: Mitral Valve Disease
PowerPoint File: Mitral Valve Repair - Management of Left Atrial Appendage

Discussion Points

• Management of Mitral Regurgitation and CAD
• Sequence of Operation
• Management of Left Atrial Appendage?
• Management of Post op Atrial Fibrillation

Further Discussion Point

• After prophylactic surgical removal of left atrial appendage, is coumadin required if a-fib subsequently develops?

Learning Points

• LAA ligation may confer additional benefit to VKA in patients undergoing MVR
• In high risk patients intolerant to VKA, LAA excision may be an alternative
• Although small sample size, LAAOS II found LAA occlusion had similar rates of strokes as VKA in patients with hx of a-fib
• For now, a history of LAA occlusion should not affect the decision of whether to anticoagulate