Ghinescu Mihnea, Franke Ulrich F W, Ortega Melisa, Hüther Franziska, Rufa Magdalena I, Göbel Nora
Department of Cardiovascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany.
Front Cardiovasc Med. 2023 Mar 2;10:1074777. doi: 10.3389/fcvm.2023.1074777. eCollection 2023.
Surgical closure of the left atrial appendage (LAA) in patients with atrial fibrillation undergoing cardiac surgery can decrease the risk of stroke and thromboembolism and should therefore be considered. In minimally invasive, thoracoscopic, or robotic-assisted mitral valve surgery, however, external procedures such as clip application or epicardial resection are not feasible due to anatomic limitations and the reduced size of the access port. Internal suture closing techniques bear the risk of recurrent LAA reperfusion, so far. We present a novel surgical technique of LAA excision and subsequent defect closure from the interior aspect of the atrium.
We developed this novel technique during robotic-assisted cardiac surgeries. In short, the LAA is invaginated into the left atrium, excised completely at the base using scissors and the stump is then closed from the inside with a two-layer looped PTFE suture. We give a detailed step-by-step description of the technique.
A total of 20 patients received intra-atrial LAA excision so far. Complete resection of the LAA without any residual stump or bleeding was achieved in all cases. There were no procedure-related complications.
The intra-atrial LAA excision technique shows promising preliminary results regarding efficacy, safety, and reproducibility during robotic-assisted cardiac operations and could be recommended for all right-sided minimally invasive cardiac surgical procedures.
对于接受心脏手术的房颤患者，手术闭合左心耳（LAA）可降低中风和血栓栓塞风险，因此应予以考虑。然而，在微创、胸腔镜或机器人辅助二尖瓣手术中，由于解剖学限制和手术入路端口尺寸减小，诸如夹子应用或心外膜切除等外部操作不可行。到目前为止，内部缝合闭合技术存在LAA再灌注复发的风险。我们提出一种从心房内部切除LAA并随后闭合缺损的新型手术技术。
我们在机器人辅助心脏手术过程中开发了这种新技术。简而言之，将LAA内翻入左心房，在基部用剪刀完全切除，然后用两层环形聚四氟乙烯缝线从内部闭合残端。我们对该技术进行了详细的分步描述。
到目前为止，共有20例患者接受了心房内LAA切除。所有病例均实现了LAA的完全切除，无任何残留残端或出血。无手术相关并发症。
心房内LAA切除技术在机器人辅助心脏手术期间在疗效、安全性和可重复性方面显示出有前景的初步结果，可推荐用于所有右侧微创心脏手术。
