Cardiac surgery Left atrial appendage stapling during totally thoracoscopic ablation of long-standing lone persistent atrial fibrillation – lessons learnt

Witkowska, Anna; Smoczyński, Radosław; Drobiński, Dominik; Kosior, Dariusz A.; Sypuła, Sławomir; Niewińska, Monika; Kaliciński, Z; Szafron, Bartłomiej; Świstowski, Jarosław; Suwalski, Piotr

doi:10.5114/kitp.2013.39732

Cited by 1 publication

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“…For this purpose, it is possible to use endoscopic Endo-GIA stapler with the reloads Tri-Staple (Medtronic, Minneapolis, USA), which shows very good properties in hermetic tissue squeezing with a sealed stapling line. However, due to the fact that the appendage is cut off there exists the risk of tear and life-threatening bleeding (54). Recently good results have been reported…”

Section: Laa Exclusionmentioning

confidence: 99%

Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation

Witkowska

Suwalski

2021

J Thorac Dis

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Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts' opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder.

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Section: Laa Exclusionmentioning

confidence: 99%