Stroke Prevention With Totally Thoracoscopic Left Atrial Appendage Epicardial Clipping System In High Risk Patietns With Atrial Fibrillation
Anna Witkowska1, Grzegorz Suwalski2, Dominik Drobinski1, Jakub Staromlynski1, Radoslaw Smoczynski1, Dariusz Kosior1, Piotr Suwalski1.
1Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland, 2Military Institute of Medicine in Warsaw, Warsaw, Poland.
OBJECTIVE: In approximately 90% the source of thrombotic material is left atrial appendage (LAA). The standard of care remains oral anticoagulation, however not every patient is feasible for this therapy. While in literature it is indicated that the LAA closure might be not inferior to oral anticoagulation, a number of novel techniqes for LAA exclusion have been recentley described.Here we present early resultes of the novel clipping system for the totally thoracoscopic epicardial LAA exclusion for pirmary and secondary stroke prevention in high risk patients with atrial fibrillation.
METHODS: 20 patients (nine women) in mean age of 72(+/-9) years with long-standing and persistent atrial fibrillation were admitted for totally thoracoscopic LAA exclusion. All patients had significant comorbidities and the history of the oral anticoagulation intolerance or prior stroke. The mean left ventricle ejection fraction was 47(+/-16)%, the mean left atrium dimension was 46(+/-2)mm. The CHA2DS2VASC Score was from 2 to 7 and the HAS_BLED Score was from 2 to 7. In four patients concomitant totally thoracoscopic ablation was performed. In two patients concomitant endoscopic coronary artery bypass grafitng was performed. In all patients the transesophageal echocardiography was performed to rule out thrombus in the LAA and guide the deployment of the clip at the base of left atrium appendage.
RESULTS: Perioperative period was uneventful. The clip measure and deployment took 10(+/-5) min. Patients were extubated in the operating room directly after the procedure. Patients were discharged in early postoperative day. In mean follow-up of six and twelve months we observed no bleeding events, no strokes, no TIA, no mortality. Stable clip position without stump or leakage was confirmed in echocardiography or computed tomography.
CONCLUSIONS: The totally thoracoscopic LAA exclusion using novel epicardial clipping system for stroke prevention in high risk patietns is safe and effective with low risk of complications both as a stand-alone procedur or concomitant to other cardiac procedures. Our initial experiences are very promising showing very high efficacy and good safety profile. Further studies are warranted.
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