Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Feasibility of the AtriClip Pro Left Atrium Appendage Elimination Device via the Transverse Sinus in Minimally Invasive Mitral Valve Surgery

  • Received : 2021.05.26
  • Accepted : 2021.07.27
  • Published : 2021.10.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Achieving external access to and manual occlusion of the left atrial appendage (LAA) during minimally invasive mitral valve surgery (MIMVS) through a small right thoracotomy is difficult. Occlusion of the LAA using an epicardial closure device seems quite useful compared to other surgical techniques. Methods: Fourteen patients with atrial fibrillation underwent MIMVS with concomitant surgical occlusion of the LAA using double-layered endocardial closure stitches (n=6, endocardial suture group) or the AtriClip Pro closure device (n=8, AtriClip group) at our institution. The primary safety endpoint was any device-related adverse event, and the primary efficacy endpoint was successful complete occlusion of blood flow into the LAA as assessed by transthoracic echocardiography at hospital discharge. The primary efficacy endpoint for stroke reduction was the occurrence of ischemic or hemorrhagic neurologic events. Results: All patients underwent LAA occlusion as scheduled. The cardiopulmonary bypass and aortic cross-clamp times in the endocardial suture group and the AtriClip group were 202±39 and 128±41 minutes, and 213±53 and 136±44 minutes, respectively (p=0.68, p=0.73). No patients in either group experienced any device-related serious adverse events, incomplete LAA occlusion, early postoperative stroke, or neurologic complication. Conclusion: Epicardial LAA occlusion using the AtriClip Pro during MIMVS in patients with mitral valve disease and atrial fibrillation is a simple, safe, and effective adjunctive procedure.

Keywords

References

  1. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 1996;61:755-9. https://doi.org/10.1016/0003-4975(95)00887-X
  2. Kanderian AS, Gillinov AM, Pettersson GB, Blackstone E, Klein AL. Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol 2008;52:924-9. https://doi.org/10.1016/j.jacc.2008.03.067
  3. Lee R, Vassallo P, Kruse J, et al. A randomized, prospective pilot comparison of 3 atrial appendage elimination techniques: internal ligation, stapled excision, and surgical excision. J Thorac Cardiovasc Surg 2016;152:1075-80. https://doi.org/10.1016/j.jtcvs.2016.06.009
  4. Park JH, Sohn SH, Choi JW, Park EA, Hwang HY. Safety and efficacy of left atrial appendage excision using a vascular stapler. Korean J Thorac Cardiovasc Surg 2020;53:127-31. https://doi.org/10.5090/kjtcs.2020.53.3.127
  5. Ailawadi G, Gerdisch MW, Harvey RL, et al. Exclusion of the left atrial appendage with a novel device: early results of a multicenter trial. J Thorac Cardiovasc Surg 2011;142:1002-9. https://doi.org/10.1016/j.jtcvs.2011.07.052
  6. Caliskan E, Sahin A, Yilmaz M, et al. Epicardial left atrial appendage AtriClip occlusion reduces the incidence of stroke in patients with atrial fibrillation undergoing cardiac surgery. Europace 2018;20:e105-14. https://doi.org/10.1093/europace/eux211
  7. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016;18:1609-78. https://doi.org/10.1093/europace/euw295
  8. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014;130:e199-267. https://doi.org/10.1161/CIR.0000000000000041
  9. Katz ES, Tsiamtsiouris T, Applebaum RM, Schwartzbard A, Tunick PA, Kronzon I. Surgical left atrial appendage ligation is frequently incomplete: a transesophageal echocardiograhic study. J Am Coll Cardiol 2000;36:468-71. https://doi.org/10.1016/S0735-1097(00)00765-8
  10. Nishi H, Miyata H, Motomura N, et al. Which patients are candidates for minimally invasive mitral valve surgery?: establishment of risk calculators using National Clinical Database. Circ J 2019;83:1674-81. https://doi.org/10.1253/circj.CJ-19-0175
  11. Falk V, Cheng DC, Martin J, et al. Minimally invasive versus open mitral valve surgery: a consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010. Innovations (Phila) 2011;6:66-76. https://doi.org/10.1097/imi.0b013e318216be5c

Cited by

  1. Recent Advancement in the Field of MICS vol.50, pp.6, 2021, https://doi.org/10.4326/jjcvs.50.431