Significant Elevated C-reactive Protein Levels After Epicardial Clipping Of The Left Atrial Appendage
Ferdi Akca, Niels Verberkmoes.
Catharina Hospital Eindhoven, Eindhoven, Netherlands.
OBJECTIVE: Closure of the left atrial appendage (LAA) is a common addition in current arrhythmia surgery for the treatment of atrial fibrillation. Besides the mechanical and anatomical changes of the left atrium, epicardial closure of the LAA induces also biochemical effects. The aim of this study was to assess whether epicardial clipping of the LAA results in an elevated inflammatory response compared to complete removal of the LAA.
METHODS: A total of 73 patients were included in this study. All patients underwent a totally thoracoscopic Maze procedure. As part of the procedure the LAA was excluded. LAA exclusion was performed either with an epicardial clip (n = 48) or the LAA was fully amputated with an endoscopic vascular stapler (n = 25). From all patients post-operative inflammatory parameters were collected and compared between the two groups.
RESULTS: The mean age and left atrial volume index were comparable between the epicardial clip and stapler group (64 ± 8 vs. 60 ± 9 years, p=0.101; 43 ± 11 vs. 40 ± 12 mL/m2. Patients receiving LAA clipping had significantly elevated C-reactive protein levels compared to patients who had LAA stapling at the 2nd, 3rd, 4th and 5th post-operative day (219 ± 80 vs. 149 ± 75 mg/L, p=0.004, 239 ± 77 vs. 167 ± 75, p=0.008, 183 ± 75 vs. 104 ± 47, p<0.001, 129 ± 63 vs. 72 ± 28, p=0.040, respectively) (Figure 1). White blood cell count was comparable between the two groups.
CONCLUSIONS: Epicardial clipping of the LAA is a surgical technique with very high success rates of mechanical closure of the LAA. In our study we observed significant elevated levels of C-reactive protein, which could be a result of LAA tissue necrosis. Whether this inflammatory response affects the outcome of arrhythmia surgery or induces the prothrombotic state needs to be evaluated in further studies.
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