A Comparative Study of Thoracoscopic Left Atrial Appendage Clipping vs Stapled Resection

Suk Kyung Lim; Chu Hyun Kim; Ki Hong Choi; Joong Hyun Ahn; Young Keun On; Sung Mok Kim; Dong Seop Jeong

doi:10.1016/j.athoracsur.2023.09.010

A Comparative Study of Thoracoscopic Left Atrial Appendage Clipping vs Stapled Resection

Ann Thorac Surg. 2023 Sep 19:S0003-4975(23)00961-X. doi: 10.1016/j.athoracsur.2023.09.010. Online ahead of print.

Authors

Suk Kyung Lim¹, Chu Hyun Kim², Ki Hong Choi³, Joong Hyun Ahn⁴, Young Keun On³, Sung Mok Kim⁵, Dong Seop Jeong¹

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
² Department of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Center for Health Promotion, Samsung Medical Center, Seoul, Korea.
³ Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁴ Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁵ Department of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: sungmok_kim@hanmail.net.

PMID: 37734642
DOI: 10.1016/j.athoracsur.2023.09.010

Abstract

Background: The left atrial appendage (LAA) is the predominant site of thrombus formation in atrial fibrillation (AF), which is associated with ischemic stroke. This study comparatively evaluated the complete LAA closure rates between LAA clipping and stapled resections.

Methods: The study included 333 patients who underwent thoracoscopic operation with both preoperative and postoperative computed tomographic scans. Propensity score matching (4:1 ratio) was applied, matching 90 LAA clipping patients with 206 stapled resection patients. The primary end point was complete LAA closure, defined as a residual LAA depth of <1 cm on computed tomographic images obtained 1 year postoperatively.

Results: No 30-day death was observed. Complete LAA closure was achieved in 85.9% (286 of 333) of patients. After propensity score matching, the clipping group demonstrated a significantly higher complete LAA closure rate than the stapled resection group (95.6% vs 83.0%, P = .003). The residual LAA stump depth was also shorter in the clipping group compared with the stapled resection group (2.9 vs 5.3 mm, P = .001). Two patients with a residual LAA stump exhibited an association with ischemic stroke during follow-up.

Conclusions: The clipping group demonstrated a higher rate of complete LAA closure compared with the stapled resection group. Close monitoring of patients with residual LAA stumps is essential. Further research with larger cohorts is needed to elucidate impact of the residual LAA stump on thromboembolic events.