Back to 2025 Cardiac Abstracts
Prevent Stroke Using Totally Thoracoscopic Off Pump Mini-maze And Left Appengade Closure In 191 Patients
Hiroshi Ito, Masaya Takahashi, Soichi Ike, Yoshitaka Ikeda, Fumiho Sano, Manabu Sudo.
Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan.
BACKGROUND: Surgical left atrial appendage closure has been demonstrated to be an effective method for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation. Nevertheless, the evidence base in this area remains limited. This presentation will include a comprehensive account of the outcomes achieved through the implementation of complete thoracoscopic left atrial appendage closure and left atrial mini-maze surgery (Wolf-Ohtsuka procedure) at our medical center.
METHODS: The patient was positioned in the right and left lateral decubitus positions, with a total of eight ports placed in the sixth, fourth, and third intercostal spaces. The procedure was conducted via a thoracoscopic approach. Pulmonary vein isolation was achieved through the use of a radiofrequency ablation device (bipolar radiofrequency clamping device, pen-type device, AtriCure) for the isolation of the left pulmonary vein and left-sided left atrial sequestration. Left atrial appendage closure was performed using a surgical stapler (Powerd ECHELON®; Johnson & Johnson) in 137 cases and a left atrial appendage closure device (AtriClip™; AtriCure, Inc., Mason, USA, or Penditure™ LAA exclusion system®; Medtronic, MN, USA) in 54 cases. The length of the left atrial appendage was measured intraoperatively using transesophageal echocardiography or postoperatively using computed tomography, and appendage closure was defined as a length of less than 1 cm.
RESULTS: From March 2018 to November 2024, a total of 191 patients underwent the WO procedure at the hospital, including 150 males and 41 females, with an average age of 71.5 ± 9.6 years (range: 39-94 years). The mean duration of atrial fibrillation was 10.8 years, and the mean CHA2DS2-VASc score was 3.7 ± 1.7 points, with a mean HASBLED score of 2.0 ± 1.0. A total of 57 cases were identified as paroxysmal atrial fibrillation, while 100 cases were classified as persistent or long-term persistent atrial fibrillation, and 36 cases were classified as permanent atrial fibrillation. The surgical procedure was left atrial appendage closure alone (WO-II method) in 34 cases, left atrial appendage closure and left pulmonary vein isolation in 17 cases, and left atrial appendage closure and WO mini MAZE (WO-I method) in 140 cases. The mean operation time was 95.5 minutes (range: 31-294 minutes), and the mean postoperative hospital stay was seven days. Left atrial appendage closure was performed in 190 of the 191 cases (99%), with no significant difference between the automatic suture device and the left atrial appendage closure device. Anticoagulation was discontinued following the patient's consent and confirmation of sufficient informed consent, typically 1-3 months post-surgery. The rate of anticoagulation withdrawal after six months was 159 out of 163 cases (97.5%). Six months following surgery, 111 patients exhibited sinus rhythm, while 52 patients demonstrated persistent atrial fibrillation. The CHA2DS2-VASc score was 3.6 in patients who had returned to sinus rhythm and 4.1 in patients who had persistent atrial fibrillation. The annual predicted rate of stroke in these cases is reported to be approximately 3-5%. However, no cases of postoperative stroke were observed during the average postoperative observation period of three years. Moreover, the rate of sinus rhythm maintenance at four years postoperatively was 72% in the 124 cases that underwent the WO-I procedure with the WO mini MAZE and had exceeded six months. In the case of paroxysmal atrial fibrillation (48 cases), 88.54% of patients maintained sinus rhythm, while in the case of persistent/long-term persistent atrial fibrillation (76 cases), 60.94% of patients maintained sinus rhythm.
CONCLUSIONS: The Wolf-Otsuka procedure was demonstrated to be efficacious in preventing cardioembolic stroke even after anticoagulation therapy was discontinued. The Wolf-Minimize procedure also demonstrated favorable outcomes with regard to the rate of recovery to sinus rhythm. While further large-scale studies are necessary, the Wolf-Otsuka procedure may prove to be a valuable addition to the treatment of atrial fibrillation.
Back to 2025 Cardiac Abstracts
