Rhee Younju, Park Sung Jun, Lee Jae Won
Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
J Thorac Cardiovasc Surg. 2023 Aug;166(2):468-474. doi: 10.1016/j.jtcvs.2021.10.032. Epub 2021 Oct 28.
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.
左心耳是心房颤动患者发生卒中的主要来源，既往研究已证实左心耳封堵具有临床益处。最近，在微创心脏手术中，一种心外膜夹闭装置可实现左心耳的完全封堵。
本研究纳入了2015年12月至2018年12月在微创心脏手术中使用心外膜夹闭装置进行外科左心耳封堵的连续患者。微创心脏手术包括通过小切口开胸进行的心脏手术。采用心脏计算机断层扫描检查左心耳完全封堵的手术成功率。当回旋支动脉与装置之间的距离小于10毫米且无造影剂渗漏时，定义为左心耳完全封堵。
最终纳入研究的108例患者（年龄58.5±11.5岁；女性61例，占56.5%）中，103例患者术后接受了心脏计算机断层扫描。所有患者术前均有心房颤动。其中，88例（81.5%）患者同时进行了二尖瓣手术，3例（2.8%）和6例（5.6%）患者分别接受了单纯左心耳夹闭手术和初次手术消融。无早期死亡或与装置相关的并发症。手术成功率方面，95例（92.2%）患者实现了左心耳的完全封堵。在中位随访19个月（四分位间距为11.7 - 28.3个月）期间，无血栓栓塞事件或与装置相关的再次手术。
在特定患者中，心脏手术期间使用心外膜夹闭装置进行左心耳封堵可在微创心脏手术中成功实施。
