Transcatheter closure of the left atrial appendage (LAA) for stroke prevention has emerged as an alternative to systemic anticoagulation in patients with atrial fibrillation (AF) and increased stroke risk. Prophylactic occlusion or excision of the LAA during heart surgery in patients with AF has been performed for decades and may be considered in patients undergoing cardiac surgery. The main goal of mechanical closure of the LAA is to exclude the LAA completely from the blood flow. Theoretically, incomplete closure of the LAA may be associated with a remaining or even increased risk for thromboembolic events.

In this single-center experience, we examined the feasibility of device closure of significant residual leaks (color flow jet width ≥5 mm by transesophageal echocardiography [TEE]) after transcatheter or surgical LAA closure.

Transcatheter closure of an incompletely closed LAA after implantation of an LAA closure device or surgical ligation of the LAA was attempted in 18 patients. In 3 patients (17%), a significant residual leak was already present after implantation of the first closure device, and implantation of a second device was scheduled after a minimum of 45 days (the minimum time for endothelialization and stabilization of the first device). Baseline characteristics and procedural results are summarized in Table 1. Procedural success (successful implantation of a closure device) was achieved in all patients (100%). No procedural complications occurred.

Majunke N, Daehnert I, Möbius-Winkler S, Schürer S, Mangner N, Thiele H, Sandri M. Interventional Treatment of Incomplete Seal After Transcatheter or Surgical Left Atrial Appendage Closure. JACC Cardiovasc Interv. 2020 Feb 10;13(3):399-400. doi: 10.1016/j.jcin.2019.10.014. PMID: 32029259.