Safety and Efficacy of Left Atrial Appendage Excision Using a Vascular Stapler

Ji Hyeon Park; Suk Ho Sohn; Jae Woong Choi; Eun Ah Park; Ho Young Hwang

doi:10.5090/kjtcs.2020.53.3.127

Safety and Efficacy of Left Atrial Appendage Excision Using a Vascular Stapler

Korean J Thorac Cardiovasc Surg. 2020 Jun 5;53(3):127-131. doi: 10.5090/kjtcs.2020.53.3.127.

Authors

Ji Hyeon Park¹, Suk Ho Sohn¹, Jae Woong Choi¹, Eun Ah Park², Ho Young Hwang¹

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
² Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Abstract

Background: This study was conducted to evaluate the safety and efficacy of left atrial appendage (LAA) excision using a vascular stapler.

Methods: Fifty consecutive patients (mean age, 68±9 years) who underwent LAA excision using a vascular stapler during concomitant cardiac surgery were enrolled. In all patients, the excision site was evaluated using computed tomography at a median of 7 days (interquartile range, 5-13.3 days) postoperatively. The safety endpoint of this study was the occurrence of LAA excision-related events, which were defined as bleeding from the excision site that required reinforcement sutures or reoperation due to excision site bleeding. The efficacy endpoint was LAA excision failure, which was defined as a remnant LAA (a stump >1 cm in maximum length) or extravasation of radiocontrast dye.

Results: LAAs were excised using 60- and 45-mm vascular staplers in 49 patients and 1 patient, respectively. Reinforcement sutures were needed in 4 patients due to staple-line bleeding and in 4 patients due to bleeding of the surrounding tissues. No patient underwent reoperation due to staple-related bleeding. A remnant LAA was observed in 2 patients, while extravasation of radiocontrast dye was not observed in any patients.

Conclusion: LAA excision using a vascular stapler may be an effective technique for LAA exclusion. Delicate handling of the stapler device and LA tissue is required to prevent procedure-related complications.

Keywords: Arrhythmia; Atrial fibrillation; Computed tomography angiography; Thrombosis.