Mokracek Ales, Kurfirst Vojtech, Bulava Alan, Hanis Jiri, Tesarik Richard, Pesl Ladislav
From the *Department of Cardiac Surgery, Hospital of Ceske Budejovice, Ceske Budejovice, Czech Republic; and †Faculty of Health and Social Studies, University of South Bohemia, Ceske Budejovice, Czech Republic.
Innovations (Phila). 2015 May-Jun;10(3):179-82. doi: 10.1097/IMI.0000000000000169.
Left atrial appendage (LAA) plays a crucial role in the etiopathogenesis and the prevention of the stroke in patients with nonvalvular atrial fibrillation (AF). This paper presents our first experience with thoracoscopic LAA occlusion using an external clip.
We performed a total of 30 LAA occlusions with the AtriClip from left thoracoscopy approach during the period from July 2012 to July 2013. AtriClip was implanted during the bilateral thoracoscopic radiofrequency (RF) as part of left atrial ablation procedure.
Among the 30 procedures, AtriClip was once periprocedurally partially positioned. In the remaining procedures, the implantation was successful without complications. Of the 30 patients, 29 underwent transesophageal echocardiography and computer tomography examination at 3 months after the procedure. Apart from the patient with the partial clip placement, a residual pouch of 18 mm was detected in another patient. In the remaining group (28/30 patients, 93%), the exclusion was complete. No migration or any other clip implantation-related complications occurred during the follow-up. None of the patients experienced an embolization event.
Endoscopic AtriClip implantation appears to be a reproducible and safe method of LAA occlusion, with a minimal risk and a high efficiency. In our opinion, the AtriClip implantation is a reasonable part of thoracoscopic AF treatment and should be considered as an alternative tool for stroke risk reduction in patients with AF.
左心耳（LAA）在非瓣膜性心房颤动（AF）患者的发病机制及卒中预防中起着关键作用。本文介绍了我们首次使用外部夹子进行胸腔镜下LAA封堵的经验。
2012年7月至2013年7月期间，我们通过左胸腔镜入路使用AtriClip共进行了30例LAA封堵术。AtriClip在双侧胸腔镜射频消融（RF）过程中作为左心房消融手术的一部分植入。
在这30例手术中，AtriClip有1例在术中曾部分定位不当。其余手术植入成功，无并发症发生。30例患者中有29例在术后3个月接受了经食管超声心动图和计算机断层扫描检查。除了夹子放置部分不当的患者外，另一例患者检测到有18mm的残余腔隙。在其余组（28/30例患者，93%）中，封堵完全。随访期间未发生夹子移位或任何其他与夹子植入相关的并发症。所有患者均未发生栓塞事件。
内镜下AtriClip植入似乎是一种可重复且安全的LAA封堵方法，风险极小且效率高。我们认为，AtriClip植入是胸腔镜下AF治疗的合理组成部分，应被视为降低AF患者卒中风险的一种替代工具。
