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Role of Video-assisted Thoracoscopy in the Management of Stroke
Magdi Ibrahim Ahmad Muhammad.
king fahd hospital, Al madina Almunawara, Saudi Arabia.
OBJECTIVE:
We evaluated the role of surgery (anterior thoracotomy versus video-assisted thoracoscopy) in the management of stroke by obliteration of left atrial appendage in patients with chronic or intermittent nonrheumatic atrial fibrillation.
METHODS:
We conducted a prospective study from January 2008 through January 2010. All patients with chronic or intermittent nonrheumatic atrial fibrillation were identified from routine clinical practice who attended the cardiothoracic department in King Fahd Hospital are included in this study. They were 58 patients [35 male, 23 female; aged 62 ± 13.2 years]. Patients were subdivided into 2 groups; Group [A] 29 patients underwent anterior thoracotomy for obliteration of left atrial appendage and Group [B] 29 patients underwent the video-assisted thoracoscopic obliteration of left atrial appendage. Preoperative, intraoperative and postoperative variables, morbidity, occurrence or recurrence of stroke and survival are compared in both groups. All patients were followed for at least 1 year.
RESULTS:
Preoperative variables were well matched for age, sex and co morbidities between both groups. No occurrence or recurrence of stroke was observed in both groups. Operative time was statistically highly significant [p < 0.001]; it was longer in Group [B]. There was no intraoperative complication in both groups. There was no postoperative complication in both groups except two cases of superficial wound infection in group [A]. There was no any significance difference between both groups as regard duration of chest tube drainage and length of hospital stay. There was no in-hospital mortality in both groups.
CONCLUSIONS:
In chronic or intermittent atrial fibrillation patients, prophylactic left atrial appendage exclusion is suggested as a method to prevent occurrence or recurrence of stroke. The left atrial appendage obliteration can be done through either surgical approach or thoracoscopic approach but video-assisted thoracoscopy approach is effective, less invasive and it avoid complications of surgical approach.
Key Words: Stroke, Atrial fibrillation, Thoracoscopy
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