Background: Left atrial appendage (LAA) is the origin of most heart thrombi which can lead to stroke or other cerebrovascular event in patients with non-valvular atrial fibrillation (AF). This study aimed to prove safety and low complication rate of surgical LAA amputation using cut and sew technique with control of its effectiveness.
Methods: 303 patients who have undergone selective LAA amputation were enrolled in the study in a period from 10/17 to 08/20. The LAA amputation was performed concomitant to routine cardiac surgery on cardiopulmonary bypass with cardiac arrest with or without previous history of AF. The operative and clinical data were evaluated. Extent of LAA amputation was examined intraoperatively by transoesophageal echocardiography (TEE). Six months in follow up, the patients were controlled regarding clinical status and episodes of strokes.
Results: Average age of study population was 69.9 ± 19.2 and 81.9% of patients were male. In only three patients was residual stump after LAA amputation larger than 1 cm with average stump size 0.28 ± 0.34 cm. 3 patients (1%) developed postoperative bleeding. Postoperatively 77 (25.4%) patients developed postoperative AF (POAF), of which 29 (9.6%) still had AF at discharge. On 6 months follow up only 5 patients had NYHA class III and 1 NYHA class IV. Seven patients reported with leg oedema and no patient experienced any cerebrovascular event in early postoperative follow up.
Conclusion: LAA amputation can be performed safely and completely leaving minimal to no LAA residual stump.
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| http://dx.doi.org/10.1186/s12872-023-03330-8 | DOI Listing |
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[Clinical Analysis of Thoracoscopic Left Atrial Appendage Amputation].
Kyobu Geka
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Department of Surgery, Saiseikai Yamaguchi Hospital, Yamaguchi, Japan.
The left atrial appendage (LAA), a major source of thrombus formation, is also a common site for ectopic foci that initiate and maintain atrial fibrillation( AF). Depending on the patient's condition, various methods are available to exclude LAA, and each of these means is associated with advantages and disadvantages. We performed thoracoscopic stand-alone LAA amputation in 47 patients with AF, who were at risk of stroke with or without contraindications to anticoagulation therapy (between March 2017 and November 2022).
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Background: Left atrial appendage (LAA) amputation performed alongside cardiac surgery has become an increasingly established procedure to reduce stroke risk in patients with atrial fibrillation. As the recommendation levels for LAA amputation continue to rise, ample evidence assessing its perioperative safety and risk factors is of utmost interest.
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Background: Recent data demonstrated the benefit of left atrial appendage (LAA)-amputation in patients with atrial fibrillation (AF). However, the long-term impact of LAA-amputation for patients with new-onset perioperative atrial fibrillation (POAF) is still unknown.
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