Thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation.

Abstract

OBJECTIVES:

This study sought to evaluate thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation (AF).

BACKGROUND:

Closing the left atrial appendage (LAA) is an efficacious alternative to oral anticoagulation as prevention against AF-induced thromboembolism, provided that the procedure is safe and complete.

METHODS:

Thirty patients (mean age, 74 ± 5.0 years) who had had thromboembolisms were selected. A subgroup of 21 patients (mean age, 75 years; mean CHA2DS2 VASc score, 4.5) urgently needed an alternative treatment to anticoagulation: warfarin was contraindicated due to hemorrhagic side effects in 13, the international normalized ratio was uncontrollable in 7, and transient ischemic attacks had developed immediately after the warfarin dose was reduced for oncological treatment in 1. The LAA was thoracoscopically excised with an endoscopic cutter.

RESULTS:

Thoracoscopic appendectomy (mean operating time, 32 min, switched to mini-thoracotomy in 2 cases) led to no mortality and no major complications. Three-month post-operative 3-dimensional enhanced computed tomography, performed with patients' consent, confirmed the completeness of the appendectomy. Patients have been followed for 1 to 38 months (mean, 16 ± 9.7 months [18 ± 9.4 months for the subgroup]). One patient died of breast cancer 28 months after surgery. Despite discontinued anticoagulation, no patients have experienced recurrence of thromboembolism.

CONCLUSIONS:

Thoracoscopic stand-alone appendectomy is potentially safe and may allow surgeons to achieve relatively simple, complete LAA closure. Further experience may demonstrate this technique to be a viable option for thromboembolism prevention in nonvalvular AF.

• Authors: Toshiya Ohtsuka, Mikio Ninomiya, Takahiro Nonaka, Motoyuki Hisagi, Takahiro Ota, Toru Mizutani
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 62 Issue 2 Pg. 103-107 (Jul 09 2013) ISSN: 1558-3597 [Electronic] United States
• PMID: 23433566 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants

Topics

• Aged
• Aged, 80 and over
• Anticoagulants
• Atrial Appendage (diagnostic imaging, surgery)
• Atrial Fibrillation (complications)
• Contraindications
• Echocardiography, Transesophageal
• Female
• Heart Atria (diagnostic imaging)
• Humans
• Imaging, Three-Dimensional
• Male
• Middle Aged
• Secondary Prevention
• Stroke (prevention & control)
• Thoracoscopy
• Thromboembolism (prevention & control)
• Tomography, X-Ray Computed