[HSF] Routine closure of the left atrial appendage?

[Nasser F. Abou'Seada]

I totally agree with the concept.

NFA


On 7/18/07, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> A few years ago as a resident at Harefield I was once questioned by Yacoub
> as to why I was virtually obliterating the RA appengae while repairing a
> cannulation site. "The appendage is a delicate organ" he said .."it must be
> preserved at all costs - it is there for a reason". The next question which
> followed was "what are the endocrine functions of the atrial appendage?".
> Indeed if you watched yacoub cannulate he barely ever touched or
> instrumented the appendage and always left the patient with this structure
> anatomically intact.
>
> This stuck with me, not because of relevance or otherwise of the appendage
> but the realization that human bodies are complex and all parts have/had a
> part to play. We as surgeons should therefore not mutilate the human body at
> will and just cut and tie things because we can. Cut and do only what is
> necessary and leave others well alone, for we do not always know why they
> are there.
>
> Why don't you set up a randomized trial? If you demonstrate benefit and
> minimal risk to routine LAA exclusion then I am sure many will consider it.
> On the contrary if you find no benefit or harm then maybe Yacoub was right -
> the LA appendage is there for a reason and best left untouched.
>
> Ani
>
>
>
>
>
> > Date: Wed, 18 Jul 2007 12:16:23 -0500> From:
> mwertheimer at mahealthcare.com> To: OpenHeart-L at lists.hsforum.com> CC: >
> Subject: [HSF] Routine closure of the left atrial appendage?> > Given the
> substantial incidence of atrial fibrillation following cardiac> surgery, and
> the frequent need to place many of these patients on> Coumadin
> anticoagulation to reduce the risks of embolic stroke, has> anyone gone to
> routinely closing off the left atrial appendage with all> cardiac surgeries?
> It can be easily done with the use of the noncutting> endo- stapling
> device.> > _______________________________________________> OpenHeart-L
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