LAA Clip Post-Operative Instructions

When the heart pumps irregularly during Atrial Fibrillation (AF), the blood moves through the heart slower than normal, and it is prone to clot. In most cases, the clot forms in the small outpouching of the left Atrium, called the Left Atrial Appendage (LAA). The clot can then travel to the brain and cause a stroke. One of the most important management goals for those with AF is to prevent stroke. This is commonly achieved by medications which "thin" the blood. However, these medications are often not the best option for many patients due to increased risks for bleeding.

The Left Atrial Appendage device, "the clip", eliminates blood flow to the LAA and provides electrical isolation. The "clip" is delivered through a small port placed in the chest wall, while visualization is maintained by a camera. During the procedure, the position of the clip is confirmed by direct visualization as well as with transesophageal echocardiogram (special ultrasounds with a probe down the throat). This procedure is done under full anesthesia.

You will have 2 small incisions which are sutured and one (where the chest tube was) that heals on its own.

The surgeon will place a small tube in your chest to eliminate any possible air accumulation within your chest. Once the surgery is completed, you will be transported to the recovery area, where nursing will carefully monitor your status and update the surgeon as needed. The chest tube will be removed in the recovery area.

Once you are awake, alert, and your X-ray looks good, you will be discharged.

Mild to moderate pain is expected, particularly at the chest tube site. This is best managed with Tylenol (unless you are instructed to avoid this medication).

There are a few things that you will need to pay attention to:

Call 911 for any of the following:

• You have trouble breathing

Seek care immediately if:

• Blood soaks through your bandage.

• You have severe pain

• You have worsening cough

• You have chest wall puffiness or swelling

Contact your healthcare provider if:

• You have a fever (temperature over 101F) or chills.

• Your wound is red, swollen, or draining pus.

• You have nausea, vomiting, or cold sweats.

• You have questions or concerns about your condition or care.

What to expect after the Left Atrial Appendage Clip:

You will be able to take off the dressing from the chest tube site after 24 hours.

You can take showers, but use liquid soap only. Avoid washcloth or sponges. Use a clean towel every time you dry off.

Do not submerge in water until all your scabs have fallen off (this likely will be a few weeks). Avoid bathtubs, hot tubs, lakes, ocean, etc...

You can leave your incisions open to air. Occasionally the chest tube site incision can leak some yellow-pink tissue fluid. This is normal. You can cover this with gauze to absorb the fluid, if needed.

There are no specific weight lifting limitations: listen to your body and avoid activities that trigger pain for the first few days.

This surgery is not intended to treat atrial fibrillation nor any other medical problems. All medications can be resumed with the exception of blood thinners.

Medicines: You may need the following:

• Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely.

• Tylenol or NSAIDs help decrease swelling, pain or fever. These medicines are available with or without a doctor's order. Your provider will advise you if you will need to avoid either of these. Always read the medicine label and follow directions.

• Take your medicine as directed.

Self-care:

• Deep breathing and coughing will decrease your risk for a lung infection. Take a deep breath and hold it for as long as you can. Let the air out and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath. Then let the air out and cough. Repeat these steps as often as directed.

• Please see the video – How to Use the Incentive Spirometer. Scan the QR code with your phone’s camera.

• Walk several times per day. Start out with short walks around your house. If weather allows, walk outside.

• Do not drive for the 3-4 days after surgery or if you take prescription pain medications.