Charlotte van Laar1, Niels J Verberkmoes2, Hendrik W van Es3, Thorsten Lewalter4, Gan Dunnington5, Stephen Stark6, James Longoria6, Frederik H Hofman1, Carolyn M Pierce5, Dipak Kotecha7, Bart P van Putte8. 1. Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands. 2. Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands. 3. Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands. 4. Department of Medicine-Cardiology and Intensive Care, Peter Osypka Heart Center, Clinic Munich-Thalkirchen, Munich, Germany. 5. Department of Cardiothoracic Surgery, St. Helena Hospital, St. Helena, California. 6. Department of Cardiothoracic Surgery, Sutter Medical Center, Sacramento, California. 7. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. 8. Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Cardiothoracic Surgery, AMC Heart Center, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: b.p.vanputte@antoniusziekenhuis.nl.
Abstract
OBJECTIVES: This study sought to document the closure rate, safety, and stroke rate after thoracoscopic left atrial appendage (LAA) clipping. BACKGROUND: The LAA is the main source of stroke in patients with atrial fibrillation, and thoracoscopic clipping may provide a durable and safe closure technique. METHODS: The investigators studied consecutive patients undergoing clipping as part of a thoracoscopic maze procedure in 4 referral centers (the Netherlands and the United States) from 2012 to 2016. Completeness of LAA closure was assessed by either computed tomography (n = 100) or transesophageal echocardiography (n = 122). The primary outcome was complete LAA closure (absence of residual LAA flow and pouch <10 mm). The secondary outcomes were 30-day complications; the composite of ischemic stroke, hemorrhagic stroke, or transient ischemic attack; and all-cause mortality. RESULTS: A total of 222 patients were included, with a mean age of 66 ± 9 years, and 68.5% were male. The mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65 to 74 years, sex category [female]) score was 2.3 ± 1.0. Complete LAA closure was achieved in 95.0% of patients. There were no intraoperative or clip-related complications, and the overall 30-day freedom from any complication rate was 96.4%. The freedom from cerebrovascular events after surgery was 99.1% after median follow-up of 20 months (interquartile range: 14 to 25 months; 369 patient-years of follow-up), and overall survival was 98.6%. The observed rate of cerebrovascular events after LAA clipping was low (0.5 per 100 patient-years). CONCLUSIONS: LAA clipping during thoracoscopic ablation is a feasible and safe technique for closure of the LAA in patients with atrial fibrillation. The lower than expected rate of cerebrovascular events after deployment was likely multifactorial, including not only LAA closure, but also the effect of oral anticoagulation and rhythm control.
OBJECTIVES: This study sought to document the closure rate, safety, and stroke rate after thoracoscopic left atrial appendage (LAA) clipping. BACKGROUND: The LAA is the main source of stroke in patients with atrial fibrillation, and thoracoscopic clipping may provide a durable and safe closure technique. METHODS: The investigators studied consecutive patients undergoing clipping as part of a thoracoscopic maze procedure in 4 referral centers (the Netherlands and the United States) from 2012 to 2016. Completeness of LAA closure was assessed by either computed tomography (n = 100) or transesophageal echocardiography (n = 122). The primary outcome was complete LAA closure (absence of residual LAA flow and pouch <10 mm). The secondary outcomes were 30-day complications; the composite of ischemic stroke, hemorrhagic stroke, or transient ischemic attack; and all-cause mortality. RESULTS: A total of 222 patients were included, with a mean age of 66 ± 9 years, and 68.5% were male. The mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65 to 74 years, sex category [female]) score was 2.3 ± 1.0. Complete LAA closure was achieved in 95.0% of patients. There were no intraoperative or clip-related complications, and the overall 30-day freedom from any complication rate was 96.4%. The freedom from cerebrovascular events after surgery was 99.1% after median follow-up of 20 months (interquartile range: 14 to 25 months; 369 patient-years of follow-up), and overall survival was 98.6%. The observed rate of cerebrovascular events after LAA clipping was low (0.5 per 100 patient-years). CONCLUSIONS: LAA clipping during thoracoscopic ablation is a feasible and safe technique for closure of the LAA in patients with atrial fibrillation. The lower than expected rate of cerebrovascular events after deployment was likely multifactorial, including not only LAA closure, but also the effect of oral anticoagulation and rhythm control.
Authors: Charles M Pearman; James Redfern; Emmanuel A Williams; Richard L Snowdon; Paul Modi; Mark C S Hall; Simon Modi; Johan E P Waktare; Saagar Mahida; Derick M Todd; Neeraj Mediratta; Dhiraj Gupta Journal: Europace Date: 2019-05-01 Impact factor: 5.214
Authors: Manuel Castellá; Dipak Kotecha; Charlotte van Laar; Lisette Wintgens; Yakir Castillo; Johannes Kelder; David Aragon; María Nuñez; Elena Sandoval; Aina Casellas; Lluís Mont; Wim Jan van Boven; Lucas V A Boersma; Bart P van Putte Journal: Europace Date: 2019-05-01 Impact factor: 5.214
Authors: Bart Maesen; Claudia A J van der Heijden; Elham Bidar; Rein Vos; Thanos Athanasiou; Jos G Maessen Journal: Interact Cardiovasc Thorac Surg Date: 2022-02-21
Authors: Fabrizio Rosati; Gijs E de Maat; Mattia A E Valente; Massimo A Mariani; Stefano Benussi Journal: J Cardiovasc Electrophysiol Date: 2021-08-04 Impact factor: 2.942