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Closure Of The Left Atrial Appendage With An Epicardial Clip During Minimally Invasive Cardiac Surgery
Maciej Bartczak, Rados&#
322;aw Smoczy&#
324;ski, Mariusz Kowalewski, Jakub Starom&#
322;y&#
324;ski, Piotr Suwalski;
Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education,, Warsaw, Poland
BACKGROUND: The left atrial appendage is a major source of stroke in patients with atrial fibrillation, and clinical benefits of left atrial appendage occlusion have been demonstrated in previous studies. Complete exclusion of the left atrial appendage has been recently available with an epicardial clipping device in the setting of minimally invasive cardiac surgery.
METHODS: The study enrolled consecutive patients who received surgical left atrial appendage occlusion using an epicardial clipping device in a minimally invasive cardiac surgery setting from October 2015 to December 2020. The minimally invasive cardiac surgery included cardiac surgeries performed through a minithoracotomy. The procedural success of left atrial appendage complete exclusion was examined with transesophageal echocardiography. Complete exclusion of the left atrial appendage was defined as remnant device was less than 10 mm without contrast leakage.
RESULTS: Among 26 patients (age, 67.5 ± 12,5 years; 12 female, 46.1%) who were finally enrolled in the study,transesophageal echocardiography was available in 25 patients. All patients had preoperative atrial fibrillation. Of these, 18 patients underwent simultaneous mitral valve procedure, and 8 received mitral and tricuspid valve procedure and surgical ablation. There were no early deaths or device-related complications. For the procedural success rate, complete exclusion of the left atrial appendage was achieved in 24 patients (92.3%). During a median follow-up (3-10 years), there were no thromboembolic events or device-related reoperations.
CONCLUSIONS:Left atrial appendage occlusion using an epicardial clipping device during cardiac surgery can be performed successfully in a minimally invasive cardiac surgery.
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