Minimally Invasive Atrial Septal Defect Closure And Transseptal Left Atrial Appendage Ligation
Sreekumar Subramanian, Joshua Hall, Furrukh Malik, David Huneycutt.
TriStar Centennial Medical Center, Nashville, TN, USA.
OBJECTIVE: Minimally invasive closure of atrial septal defect has become very common, either via right mini-thoracotomy or robotic approaches. Atrial fibrillation is common in these patients perioperatively, and left atrial appendage ligation could be considered. The objective of this report was to review our experience with transseptal closure of the left atrial appendage at the time of minimally invasive closure of atrial septal defect.
METHODS: From 05/2016-10/2016, we performed 4 minimally invasive ASD closure operations (on patients who were ineligible for catheter-based approaches) via right mini-thoracotomy and/or partial sternotomy. Of these, 2 patients underwent concomitant transseptal direct suture ligation of the left atrial appendage. The charts of these patients were reviewed to highlight the technical aspects.
RESULTS: 2 patients (mean age 42) underwent minimally invasive patch closure of secundum ASD via right mini-thoracotomy. Both patients underwent percutaneous SVC cannulation with a 15 Fr. cannula and open femoral arterial and venous cannulation, and a right mini-thoracotomy exposure. Patient 1 (49 yo woman) had undergone catheter ablation for SVT prior to her operation, and Patient 2 (35 year old man) had significantly dilated right sided cardiac chambers. In both patients felt to be at high risk for perioperative atrial arrhythmias, prior to patch implantation for ASD closure, transseptal direct suture ligation of the left atrial appendage was performed. Completion TEE confirmed exclusion of the left atrial appendage, and an intact interatrial septum. The patients had uneventful hospital stays and were discharged on postoperative days 5 and 6, respectively.
CONCLUSIONS: In patients undergoing minimally invasive right chest operations for ASD closure, transseptal direct suture ligation of the left atrial appendage is feasible and can be performed safely. We believe that consideration should be given to this valuable adjunctive procedure, particularly in those patients who are at especially high risk for perioperative atrial fibrillation.
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