Abstract
BACKGROUND: Left main coronary artery occlusion during surgical left atrial appendage closure is a rare but critical complication. CASE SUMMARY: We report 2 cases of left main coronary artery occlusion diagnosed intraoperatively during concomitant surgical left atrial appendage closure with a clipping device via an endoscopic minimally invasive approach. Both cases were successfully managed by suturing the clip to the left atrial wall, distancing it from the coronary artery. DISCUSSION: Previous reports have documented this complication, but this is the first report of using this particular resolution method. Our approach provides a physiological solution to left main coronary artery obstruction, offering a practical and effective strategy for intraoperative management. TAKE-HOME MESSAGE: Awareness and prompt management of this complication are crucial during LAAO procedures. The novel method of suturing the clip to the cranial left atrial wall effectively resolves the issue.