Thoracoscopic stapler-and-loop technique for left atrial appendage closure in nonvalvular atrial fibrillation: Mid-term outcomes in 201 patients

Toshiya Ohtsuka; Takahiro Nonaka; Motoyuki Hisagi; Mikio Ninomiya; Ai Masukawa; Takahiro Ota

doi:10.1016/j.hrthm.2018.05.026

Thoracoscopic stapler-and-loop technique for left atrial appendage closure in nonvalvular atrial fibrillation: Mid-term outcomes in 201 patients

Heart Rhythm. 2018 Sep;15(9):1314-1320. doi: 10.1016/j.hrthm.2018.05.026. Epub 2018 May 24.

Authors

Toshiya Ohtsuka¹, Takahiro Nonaka², Motoyuki Hisagi², Mikio Ninomiya², Ai Masukawa³, Takahiro Ota⁴

Affiliations

¹ Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: ootsukadr@sd6.so-net.ne.jp.
² Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
³ Department of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
⁴ Department of Neuro-surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.

PMID: 29803851
DOI: 10.1016/j.hrthm.2018.05.026

Abstract

Background: Left atrial appendage (LAA) closure can be an alternative to oral anticoagulation to prevent cardiogenic thromboembolisms in patients with nonvalvular atrial fibrillation.

Objective: The purpose of this study was to retrospectively evaluate the safety, completeness, and mid-term prevention of our thoracoscopic stapler-and-loop technique for LAA closure.

Methods: Patients operated on between October 2008 and February 2017 were reviewed. Endoscopic stapler and ligation loops were used. Patients received 1 month of anticoagulation before discontinuation. Hospital death and procedure-related major complications (thromboembolism, hemorrhagic events, phrenic palsy) were the primary composite endpoint for safety, and cardiogenic thromboembolisms were the endpoint for prevention. Brain magnetic resonance imaging investigated new thromboembolic spots 1 year after surgery.

Results: There were 201 patients (118 men, 83 women) with a mean age of 74 years (range 68-94) years, mean CHA₂DS₂-VASc score (± SD) 4.1 ±1.4, and mean HAS-BLED score 2.9 ± 1.0. Mean operation time was 28 minutes. All LAAs were removed, and intraoperative transesophageal echocardiography confirmed completeness of the closure in each patient. No hospital deaths or major procedure-related complications occurred. Follow-up results for 198 patients (98%) over a mean period of 48 months (range 12-110) revealed that 2 patients developed cardiogenic thromboembolisms (0.25 event per 100 patient-years). Magnetic resonance imaging of 51 patients with a mean CHA₂DS₂-VASc score of 4.7 ± 1.6 revealed 1 new small spot in each of 2 patients (3.9%; 3.9 spots per 100 patient-years).

Conclusion: Our thoracoscopic stapler-and-loop technique swiftly, safely, and completely closed LAAs in patients with nonvalvular atrial fibrillation and provided acceptable mid-term prevention without anticoagulation.

Keywords: Cardiogenic thromboembolism; Left atrial appendage; Nonvalvular atrial fibrillation; Stapler; Thoracoscopic surgery.

MeSH terms

Aged
Aged, 80 and over
Anticoagulants / therapeutic use
Atrial Appendage / diagnostic imaging
Atrial Appendage / surgery*
Atrial Fibrillation / complications
Atrial Fibrillation / surgery*
Cardiac Surgical Procedures / methods*
Echocardiography, Transesophageal
Female
Follow-Up Studies
Humans
Male
Retrospective Studies
Surgical Staplers*
Suture Techniques / instrumentation*
Thoracoscopy / methods*
Thromboembolism / etiology
Thromboembolism / prevention & control*
Time Factors
Treatment Outcome

Substances

Anticoagulants