Innovative Surgical Left Atrial Appendage Closure Technique: Early Experience Of Inverted Spiral Closure Technique
Eiki Nagaoka, MD, PhD., Hirokuni Arai, MD, PhD., Tomohiro Mizuno, MD, PhD., Keiji Oi, MD, PhD., Tatsuki Fujiwara, MD, PhD., Kiyotoshi Oishi, MD., Mayumi Suzuki, MD, PhD..
Tokyo Medical and Dental University, Tokyo, Japan.
BACKGROUND: To prevent cardiogenic embolic event following atrial fibrillation, the left atrial appendage (LAA) closure simultaneously with cardiac procedures has been widely adopted. However, in minimally invasive mitral valve surgery through right mini-thoracotomy, access to left atrial appendage is limited. Surgical LAA exclusion with endoluminal sutures are well known with considerable number of closure failure.
METHODS: We propose a new surgical LAA closure technique comprise with a spiral suture on an inverted LAA and following mattress sutures for secure. This technique is named as inverted spiral closure technique (ISCT). Concept of the technique is based on that dead space in LAA should be eliminated for complete occlusion. Since July 2020, 21 patients underwent LAA closure with ISCT concomitant with mitral valve surgery in our hospital. Early postoperative outcomes and any stroke or arterial embolic event during the follow up are evaluated. Tans-thoracic echocardiography (TTE) or trans-esophageal echocardiography (TEE) was used to assess LAA patency.
RESULTS: Median age of the patients was 69 years (range: 33 - 82). 18 (86%) were male. 10 (48%) had atrial fibrillation (AF) or paroxysmal AF preoperatively. Concomitant procedures were tricuspid valve repair in 17 (81%), aortic valve replacement in 6 (29%), and Maze procedure in 5 (24%) patients. In all cases, procedures were performed successfully through an interatrial left atriotomy. No significant persistent flow between left atrium and LAA was observed on intraoperative TEE. During a median of 6 (0 - 17) months follow-up, no patients experienced stroke, myocardial infarction, or death. Echocardiographic evaluations (20 in TTE and 1 in TEE) at 6 to 12 months after operation showed no significant residual flow from LAA.
CONCLUSIONS: Inverted Spiral Closure Technique which can be performed through a same left atriotomy for mitral valve procedure is a useful and effective procedure for surgical left atrial appendage exclusion. The number of the patients and modalities for postoperative evaluation are still insufficient. Further meticulous follow-up is necessary for exact evaluation of the procedure.
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