Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Center for Health Promotion, Samsung Medical Center, Seoul, Korea.
Ann Thorac Surg. 2024 Jun;117(6):1230-1236. doi: 10.1016/j.athoracsur.2023.09.010. Epub 2023 Sep 19.
The left atrial appendage (LAA) is the predominant site of thrombus formation in atrial fibrillation (AF), which is associated with ischemic stroke. This study comparatively evaluated the complete LAA closure rates between LAA clipping and stapled resections.
The study included 333 patients who underwent thoracoscopic operation with both preoperative and postoperative computed tomographic scans. Propensity score matching (4:1 ratio) was applied, matching 90 LAA clipping patients with 206 stapled resection patients. The primary end point was complete LAA closure, defined as a residual LAA depth of <1 cm on computed tomographic images obtained 1 year postoperatively.
No 30-day death was observed. Complete LAA closure was achieved in 85.9% (286 of 333) of patients. After propensity score matching, the clipping group demonstrated a significantly higher complete LAA closure rate than the stapled resection group (95.6% vs 83.0%, P = .003). The residual LAA stump depth was also shorter in the clipping group compared with the stapled resection group (2.9 vs 5.3 mm, P = .001). Two patients with a residual LAA stump exhibited an association with ischemic stroke during follow-up.
The clipping group demonstrated a higher rate of complete LAA closure compared with the stapled resection group. Close monitoring of patients with residual LAA stumps is essential. Further research with larger cohorts is needed to elucidate impact of the residual LAA stump on thromboembolic events.
左心耳（LAA）是房颤（AF）中血栓形成的主要部位，与缺血性中风有关。本研究比较了 LAA 夹闭与缝合切除术之间完全 LAA 闭合率。
本研究纳入了 333 例接受胸腔镜手术且术前和术后均行计算机断层扫描的患者。采用倾向评分匹配（4:1 比例），将 90 例 LAA 夹闭患者与 206 例缝合切除患者进行匹配。主要终点为完全 LAA 闭合，定义为术后 1 年计算机断层扫描图像上残余 LAA 深度<1cm。
无 30 天死亡。333 例患者中，有 85.9%（286 例）达到完全 LAA 闭合。经过倾向评分匹配后，夹闭组的完全 LAA 闭合率明显高于缝合切除组（95.6% vs 83.0%，P=0.003）。夹闭组残余 LAA 残端深度也短于缝合切除组（2.9 vs 5.3mm，P=0.001）。两名残余 LAA 残端患者在随访期间出现缺血性中风相关事件。
夹闭组与缝合切除组相比，完全 LAA 闭合率更高。对残余 LAA 残端患者需密切监测。需要进一步的大样本研究来阐明残余 LAA 残端对血栓栓塞事件的影响。
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