Comparative Study Between Left Atrial Appendage Resection With Vascular Stapler And Left Atrial Appendage Closure With Atrial Clip
Kanan Kurahashi, Takaharu Shimizu, Satoshi Nishi, Akihiro Yoshimoto, Sei Morizumi, Yoshihiro Suematsu.
Tsukuba Memorial Hospital, Ibaraki, Japan.
Background: Left atrial appendage (LAA) is known as a major source of thrombus formation in atrial fibrillation (AF), and several approaches to manage LAA have been reported to be effective to prevent cardiogenic thromboembolism. Post-operative AF occurs in about 30% of patients who underwent cardiac surgery, and performing LAA resection (LAAR) or LAA closure (LAAC) during open cardiac surgery is considered an option to prevent cardiogenic thromboembolism in post-operative course. In conventional cardiac surgery LAA was occluded using purse-string sutures but recently new devices are introduced for safer and more effective LAA occlusion. Methods: A total of 13 patients underwent LAAR with vascular stapler device (n=7, all male patients, average age of 71 years old) or LAAC with atrial clip device (n=6, 3 male, 3 female patients, average age of 77.2 years old) during open cardiac surgery. 10 of 13 patients had been diagnosed as AF before the operation and 7 patients had suffered from previous cardiogenic thromboembolism such as cerebral and myocardial infarction, critical limb ischemia, and 2 from bleeding such as cerebral and gastrointestinal hemorrhage. Pre- and post-operative CT-CAG scan were performed on 4 patients who underwent LAAR and 5 patients who underwent LAAC. Median observation period was 5 months. Results: Both devices showed similar surgical margins (image), but thrombus formation was confirmed along the surgical margin of the LAA in 2 patients who underwent LAAR (and none in LAAC) and use of anticoagulants were required in the post-operative course. There were no intraoperative difficulties considering LAAR and LAAC. All patients were free from operation-related death and other adverse events, including cerebrovascular accidents and other thromboembolism. Conclusions: Both LAAR and LAAC can be a safe option to prevent post-operative thromboembolism. Although no difficulties were observed intraoperatively, LAAC can be even safer in terms of hemostasis under systemic heparinization. Furthermore, post-operative CT-CAG scans are recommended to rule out thrombus formation along the surgical margin of the LAA which possibly causes post-operative thromboembolism. 
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