Use of tissue welding technology to obliterate left atrial appendage - novel use of LigasureTM

Abstract

The left atrial appendage is one source of thromboemobolus. Complete occlusion of this appendage is required to sever communication with the left atrium; however, current ligation techniques can potentially leave residual communication. A novel technique of occluding the appendage has been developed using a bipolar device and radiofrequency energy. Twelve patients underwent an off-pump, epicardial Maze procedure using radiofrequency ablation. As an adjunct to the procedure, ligation of the left atrial appendage was completed using the LigaSure Xtd™ (Valleylab, Tyco Healthcare, Boulder, CO) with a modified application technique. Patients were followed to ensure sinus or paced rhythm. All twelve patients are in sinus or paced rhythm upon follow-up. Four patients required pacemakers for sick sinus syndrome. To date there have been no incidents of strokes, thromboembolic events, postoperative bleeding or deaths in all patients. Complete occlusion of the left atrial appendage is necessary to eliminate communication, which is accomplished by this radiofrequency, bipolar device. Extensive studies are necessary to verify the efficacy of this novel occluding technique.