Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany.
BMC Cardiovasc Disord. 2023 Jun 20;23(1):308. doi: 10.1186/s12872-023-03330-8.
Left atrial appendage (LAA) is the origin of most heart thrombi which can lead to stroke or other cerebrovascular event in patients with non-valvular atrial fibrillation (AF). This study aimed to prove safety and low complication rate of surgical LAA amputation using cut and sew technique with control of its effectiveness.
303 patients who have undergone selective LAA amputation were enrolled in the study in a period from 10/17 to 08/20. The LAA amputation was performed concomitant to routine cardiac surgery on cardiopulmonary bypass with cardiac arrest with or without previous history of AF. The operative and clinical data were evaluated. Extent of LAA amputation was examined intraoperatively by transoesophageal echocardiography (TEE). Six months in follow up, the patients were controlled regarding clinical status and episodes of strokes.
Average age of study population was 69.9 ± 19.2 and 81.9% of patients were male. In only three patients was residual stump after LAA amputation larger than 1 cm with average stump size 0.28 ± 0.34 cm. 3 patients (1%) developed postoperative bleeding. Postoperatively 77 (25.4%) patients developed postoperative AF (POAF), of which 29 (9.6%) still had AF at discharge. On 6 months follow up only 5 patients had NYHA class III and 1 NYHA class IV. Seven patients reported with leg oedema and no patient experienced any cerebrovascular event in early postoperative follow up.
LAA amputation can be performed safely and completely leaving minimal to no LAA residual stump.
左心耳（LAA）是大多数心源性血栓的起源，可导致非瓣膜性心房颤动（AF）患者中风或其他脑血管事件。本研究旨在证明使用切割和缝合技术进行 LAA 切除的安全性和低并发症率，并控制其有效性。
在 2017 年 10 月至 2020 年 8 月期间，我们对 303 例选择性 LAA 切除患者进行了研究。在体外循环和心脏停搏的情况下，同时进行 LAA 切除和常规心脏手术，无论是否有 AF 病史。评估了手术和临床数据。术中通过经食管超声心动图（TEE）检查 LAA 切除的范围。在随访的 6 个月中，控制患者的临床状况和中风发作情况。
研究人群的平均年龄为 69.9±19.2 岁，81.9%的患者为男性。仅 3 例患者的 LAA 切除后残端大于 1cm，平均残端大小为 0.28±0.34cm。3 例（1%）患者术后发生出血。术后 77 例（25.4%）患者发生术后心房颤动（POAF），其中 29 例（9.6%）出院时仍有 AF。在 6 个月的随访中，只有 5 例患者为纽约心脏协会（NYHA）心功能分级 III 级，1 例为 NYHA 心功能分级 IV 级。7 例患者报告腿部水肿，无患者在术后早期随访中发生任何脑血管事件。
LAA 切除可以安全且完全地进行，仅留下最小或没有 LAA 残端。
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