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International Society For Minimally Invasive Cardiothoracic Surgery

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First Results Of A Surgical Stand-alone Left Atrial Appendage Management Programm In Germany
Monique Schermer, Vladimir Vulevic, Michael Lass, Thorsten Hanke.
Asklepios Klinikum Harburg, Hamburg, Germany.

Background: Epidemiologically, atrial fibrillation is the most prevalent cardiac arrhythmia with a prevalence of 1.5-2%. This disease is associated with an increased risk of comorbidities and mortality, e.g. cardiac embolisation from the LAA with recurrent cerebral infarction. Hence, these apatients are usually treated with oral anticoagulants. However, some patients are not suitable for oral anticoagulation due to bleeding complications. In these patients, an epicardial minimal invasive surgical occlusion of the LAA is feasible. The purpose of this study is to report the first results of a newly implemented surgical LAAM programm and the benefits of left atrial appendage occlusion surgery.
Methods: 35 patients were analyzed being treated with isolated stand-alone left atrial appendage occlusion surgery. LAAM was performed in all pts. with a clip device (Atri Clip Pro 2, Atriflex). The baseline, periprocedural and outcome parameters were considered. All patients had an indication for LAAM as supported by the 2019 AHA guidelines (IIb B-NR ;GI bleeding 49%, Stroke 31%, GI embolization 11%, delicate INR 9%).
Results: 15 patients were female (42,86%). The average age was 76 years, average BMI was 27. Mean LogEuroScore was 5,3% 11,3, mean CHA2DS-VASC Sore 4,21,5 and mean HAS-BLED 3,8 1,1. Women showed a higher risk profile than men. 12 pts. suffered from paroxysmal atrial fibrillation (34,29%), 9 from persistent atrial fibrillation (25,71%) and 14 from long-lasting persistent atrial fibrillation (40%). 8 patients received a vitamin K antagonist (22,86%), 19 patients received DOAKs (54,29%) and 8 patients low-molecular heparin (22,86%). 6 (17,14%) patients were transferred as an emergency procedure. 29 patients received a left sided minimal thoracotomy (82,86%) and 5 patients were treated thoracoscopically (14,29%). 1 emergency patient (2,86%) had to be treated by median sternotomy. 1 major bleeding (2,86%) and 2 re-thoracatomies (5,71%) were necessary. 1 patient died (2,86%) due to preprocedural embolic intestinal ischemia. No patient suffered a stroke or a TIA. At discharge, all patients were off oral anticoagulation. 8 patients (22,86%) continued to take antiplatelet therapy due to preexisting coronary heart disease.
Conclusion: Surgical minimally invasive epicardial clip occlusion of the left atrial appendage is a safe and feasible option for LAA closure in patients with a contraindication for oral anticoagulation, especially with respect to neurological outcome. For final judgement, a larger study with longer follow-up is warranted.


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