Left Atrium Compression by Iatrogenic Hematoma Due to Left Atrial Appendage Clipping in Open Coronary Artery Bypass Grafting Surgery

Left atrial appendage (LAA) clipping during open cardiac surgery is widely used for stroke and embolization prevention in atrial fibrillation. Various devices are available for this purpose, including the AtriCure AtriClip and the recently introduced Medtronic Penditure clip. We present a case of a 59-year-old male with multiple comorbidities, including chronic kidney disease and coronary artery disease, who underwent coronary artery bypass grafting with prophylactic LAA clipping using the Medtronic Penditure atrial clip. The procedure was complicated by an iatrogenic hematoma due to clip erosion into the atrioventricular groove, leading to left atrial tamponade and necessitating chest re-exploration. This case underscores the importance of understanding the structural interactions between different LAA occlusion devices and surrounding cardiac anatomy. Further evaluation is warranted to assess the safety profile of newer LAA occlusion devices and their impact on postoperative outcomes.