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Early Operative Comparison of Two Epicardial Left Atrial Appendage Occluding Systems Applied During Off-Pump Coronary Revascularization
Grzegorz Suwalski1, Robert Emery2, Leszek Gryszko3, Kamil Kaczejko3, Emilia Frankowska3, Arkadiusz Zegadlo3, Andrzej Skrobowski3.
1Military Institute of Health Service, Warsaw, Poland, 2Department of Cardiac Surgery St Joseph’s Hospital, Minnesota, MN, USA, 3Military Institute of Medicine, Warsaw, Poland.

OBJECTIVE: Atrial fibrillation (AF) increases long-term mortality and stroke rate in patients having coronary artery bypass grafting (CABG). Since oral anticoagulation (OAC) is associated with both a significant incidence of discontinuation and well known complication rates, left atrial appendage occlusion might be beneficial for stroke prevention. This study compares two epicardial left appendage occluders (LAAO) accruing experience in application during off-pump coronary revascularization in patients with persistent AF.
METHODS: Twenty two consecutive patients with persistent AF were assigned to intraoperative LAA occlusion with either Tiger Paw System II(n=11) or AtriClip (n=11) device during off-pump CABG and concomitant left atrial epicardial ablation. Both systems were analyzed in terms of ease and safety of application along with intraoperative LAA occlusion success.
RESULTS: Surgical risk was increased in the study population (mean EuroScore II: 3,2 +/-0,3 %). In all patients in AtriClip group successful off-pump LAA occlusion confirmed by intraoperative transoesophageal echocardiography was achieved. Tiger Paw application was generally quicker and easier, however in 2 patients application was not successful. During the hospital stay there were no bleeding or thrombo-embolic events recorded.
CONCLUSIONS: Epicardial LAAC during off-pump CABG in patients with persistent AF can be easily, safely and successfully performed with both presented devices, but it seems that Tiger Paw system requires technological improvement. It might be useful to adapt the use of the type of occluding device to LAA morphologic type and target revascularization vessels to avoid the additional use of a heart positioner use or obviate coronary compression.

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