What is the role of left atrial appendage management during CABG when atrial fibrillation is present?

• A. Always closed
• B. Left atrial appendage closure can be considered to reduce stroke risk, though not universal
• C. It is contraindicated
• D. It has no impact on stroke risk

Answer: (B)

In atrial fibrillation, the left atrial appendage is a common site where blood can stagnate and form clots that travel to the brain and cause stroke. During CABG, closing or occluding the left atrial appendage can be done if feasible, with the goal of reducing the chance that a clot from the appendage leads to a thromboembolic event after surgery. This approach is not mandatory for every patient; the decision depends on factors like individual stroke risk, anatomy, and surgical judgment. So, the best choice reflects that left atrial appendage closure can be considered to reduce stroke risk, though it is not universal. It is not contraindicated, and it can have a meaningful impact on stroke risk in selected patients, though it does not guarantee prevention.