Methods and Criteria for Evaluating the Success of Surgical Left Atrial Appendage Closure: A Systematic Review

OBJECTIVES: Surgical left atrial appendage closure (LAAC) is recommended as a concomitant procedure during cardiac surgery in patients with atrial fibrillation to reduce stroke risk, but the methods and criteria used to evaluate procedural success remain poorly standardized. This systematic review aims to identify and describe the imaging modalities, evaluation criteria, and validation methods used to assess the success of surgical LAAC. METHODS: A systematic literature search was conducted in Embase, MEDLINE, and the Cochrane Library. Clinical studies reporting intraoperative or postoperative evaluation of surgical LAAC were included. Data were extracted on imaging modality, timing of assessment, criteria for procedural success, measurement techniques, validation efforts, and reported success rates. RESULTS: Eighty studies comprising 7517 patients and 10 375 imaging examinations were included. Transesophageal echocardiography was the most frequently used imaging modality (83%), primarily for intraoperative assessment, while cardiac computed tomography was used in 44% of studies for postoperative evaluation. Seventeen different definitions of procedural success were identified. The most commonly applied definitions were absence of persistent flow between the left atrium and LAA and a residual stump length