Epicardial left atrial appendage clip occlusion in patients with atrial fibrillation during minimally invasive cardiac surgery.

Abstract

The left atrial appendage is a major source of stroke in patients with atrial fibrillation, and clinical benefits of left atrial appendage occlusion have been demonstrated in previous studies. Complete exclusion of the left atrial appendage has been recently available with an epicardial clipping device in the setting of minimally invasive cardiac surgery. The study enrolled consecutive patients who received surgical left atrial appendage occlusion using an epicardial clipping device in a minimally invasive cardiac surgery setting from December 2015 to December 2018. The minimally invasive cardiac surgery included cardiac surgeries performed through a minithoracotomy. The procedural success of left atrial appendage complete exclusion was examined with cardiac computed tomography. Complete exclusion of the left atrial appendage was defined when the distance from circumflex artery to the device was less than 10 mm without contrast leakage. Among 108 patients (age, 58.5 ± 11.5 years; 61 female, 56.5%) who were finally enrolled in the study, postoperative cardiac computed tomography was available in 103 patients. All patients had preoperative atrial fibrillation. Of these, 88 patients (81.5%) underwent simultaneous mitral valve procedure, and 3 (2.8%) and 6 (5.6%) received stand-alone procedure of left atrial appendage clipping and primary surgical ablation, respectively. There were no early deaths or device-related complications. For the procedural success rate, complete exclusion of the left atrial appendage was achieved in 95 patients (92.2%). During a median follow-up of 19 months (interquartile range, 11.7-28.3 months), there were no thromboembolic events or device-related reoperations. Left atrial appendage occlusion using an epicardial clipping device during cardiac surgery can be performed successfully in a minimally invasive cardiac surgery setting in selected patients.