Totally Thoracoscopic Left Atrial Appendage Closure And Ablation In Nonvalvular Atrial Fibrillation
Hiroshi Ito, Fumiho Sano, Takahiro Mizoguchi, Masaya Takahashi, Yoshitaka Ikeda.
Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan.
BACKGROUND:Totally thoracoscopic left atrial appendage closure and ablation (Wolf-Ohtsuka :WO procedure) is a minimally invasive surgical treatment with the primary goal of discontinuing anticoagulation therapy and the secondary goal of ablation. We investigated the usefulness of WO procedure at our hospital.
The 105 patients underwent WO procedure at our hospital from March 2018 to August 2022 included 83 males and 22 females, ranging in age from 43 to 85 years old, with a mean age of 70.7 ± 8.3 years. The mean CHA2DS2-VASc score was 3.8±1.5 and HASBLED score 2.1±1.0. 67 patients received WO-I procedure (LAA closure plus totally thoracoscopic Wolf mini MAZE), others received LAA closure with/without left side pulmonary vein isolation. 79 patients were resected by stapler and 26 patients were closed by AtriClip devices. LAA stump length was measured by intraoperative transesophageal echocardiography or postoperative CT, and LAA closure was defined as less than 1 cm.RESULTS:The mean operative time was 121 minutes (31-294 minutes), and the mean postoperative hospital stay was 6.6 days. Complete LAA closure was achieved in 104/105 (99%) of patients, with no difference between staplers and AtriClip devices. Anticoagulation therapy was discontinued 3 months postoperatively, and the anticoagulation withdrawal rate at 6 months was 97 (97%). The CHA2DS2-VASc score was 3.56 for patients returning to sinus rhythm and 4.05 for patients with persistent atrial fibrillation. No postoperative cardiogenic embolism was observed in any of the patients, although the predicted annual incidence of cardiogenic embolism in these patients has been reported to be around 3-5%, respectively. In the 67 WO-I patients who underwent TT MAZE, the recovery rate for sinus rhythm at 3, 6, and 12 months was 87%, 87%, and 85%, respectively, including 79%, 79%, and 79% in the 39 patients with preoperative persistent atrial fibrillation. The major complication was intraoperative hemorrhage, which resulted in open conversion for hemostasis in one case.
CONCLUSIONS:The LAA closure using WO procedure prevented cardiogenic embolism and enabled weaning from anticoagulation, and simultaneous ablation resulted in a satisfactory recovery rate to sinus rhythm.
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