Standalone Totally Thoracoscopic Left Appendage Clipping: Safe, Simple, Standardized

Branzoli, Stefano; Marini, Massimiliano; Guarracini, Fabrizio; Pederzolli, Carlo; D'Onghia, Giovanni; Centonze, Maurizio; Pomarolli, Claudio; Graffigna, Angelo; Meir, Mark La

doi:10.1016/j.athoracsur.2020.04.130

Cited by 8 publications

(12 citation statements)

References 9 publications

(4 reference statements)

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“…12 On the other hand, the AtriClip closure device has been shown to be effective and safe in the closure of the LAA. [13][14][15][16] Ad et al 17 showed that the latest iteration of the AtriClip, the AtriClip ProV, can also be successfully deployed during a right thoracotomy approach. Ultimately, this is why even with the promising stroke mitigation results demonstrated in the recent LAAOS III trial, it is important to acknowledge that most (85%) of these patients had what we feel are suboptimal approaches to the closure of the LAA.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Appendage Ligation Using the AtriClip Device: Single-Center Study of Device Safety and Efficacy

Kiankhooy

2022

Innovations�(Phila)

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Objective Left atrial appendage (LAA) occlusion at the time of cardiac surgery in patients with atrial fibrillation has been shown to reduce the incidence of postoperative embolic stroke. However, the optimal method for LAA occlusion is not universally accepted. We sought to examine the safety and effectiveness of LAA occlusion with the AtriClip epicardial occlusion device. Methods Cardiac surgical patients with atrial fibrillation who underwent LAA AtriClip placement were evaluated prospectively. Clip placement and clinical outcomes were examined after 1 year of follow-up with transesophageal echocardiography (TEE). The presence of a 10 mm or greater residual pouch, presence of flow into the LAA, or device-related thrombus (DRT) were considered failures. Results Ninety-seven patients were analyzed. The mean CHA2DS2-VASc score was 2.4 ± 1.4. The postoperative follow-up period ranged from 366 to 1,693 days (mean 685 days or 1.87 years). Seventy-four AtriClips were placed with video-assisted thoracic surgery, whereas 23 were placed via sternotomy or thoracotomy. Successful closure was found in 96% (93 of 97) of patients at follow-up. Failure occurred in 4 patients. No clip migration or DRT was seen on 3-dimensional imaging. Of all 97 patients, 76 (78%) were on presurgical oral anticoagulation, whereas 5 (5.1%) were on postprocedure oral anticoagulation. There were no postoperative thromboembolic events at the time of the study TEE. Conclusions The AtriClip epicardial surgical occlusion device can provide an excellent rate of successful closure of the LAA during surgical ablation procedures without DRT.

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Section: Discussionmentioning

confidence: 99%

Left Atrial Appendage Ligation Using the AtriClip Device: Single-Center Study of Device Safety and Efficacy

Kiankhooy

2022

Innovations�(Phila)

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“…The procedure was performed as described previously [ 21 ]. Briefly, three ports in a “hockey stick” configuration were introduced in the left hemithorax between the anterior and mid-axillary line in the III, V, and VII intercostal space.…”

Section: Methodsmentioning

confidence: 99%

Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective

Branzoli

Guarracini

Marini

et al. 2022

JCM

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Background: Left atrial appendage occlusion is an increasingly proposed treatment for patients with atrial fibrillation and poor tolerance to anticoagulants. All endovascular devices require antithrombotic therapy. Anatomical and clinical variables predisposing to device-related thrombosis, as well as post-procedural peri-device leaks, could mandate the continuation or reintroduction of aggressive antithrombotic treatment. Because of the absence of foreign material inside the heart, epicardial appendage closure possibly does not necessitate antithrombotic therapy, but data of large series are missing. Methods: Multidisciplinary team evaluation for standalone totally thoracoscopic epicardial appendage closure was done in 180 consecutive patients with atrial fibrillation and poor tolerance to antithrombotic therapy. One hundred and fifty-two patients consented (male 66.1%, mean age 76.1 ± 7.4, CHA2DS2VASc mean 5.3 ± 1.6, HASBLED mean 3.8 ± 1.1). Indications were cerebral hemorrhage (48%), gastro-intestinal bleeding (33.3%), and other bleeding (20.7%). No antithrombotic therapy was prescribed from the day of surgery to the latest follow up. Results: Procedural success was 98.7%. At a mean follow up of 38.2 ± 18.8 months, cardioembolic and bleeding events were 1.3% and 0.6%, respectively. Among patients with a history of blood transfusions (41.1%), none needed further transfusions or treatment post procedure. Conclusion: Epicardial appendage occlusion without any antithrombotic therapy appears to be safe and effective. This strategy could be advised when minimization of bleeding risk concomitant to stroke prevention is needed.

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“…The procedure was performed as described previously [ 20 ]. Briefly, with the patient in supine position, standard monitoring system and defibrillation pads, three 12-mm ports in a ‘hockey stick’ figure were placed: in the fifth intercostal space along the mid axillary line, third intercostal space along the anterior axillary line, and sixth–seventh intercostal space between the anterior and mid axillary line.…”

Section: Methodsmentioning

confidence: 99%

“…Echocardiography plays an important role when LAAO is a therapeutic option, not only during the pre-procedural phase, to detect the presence of LAA thrombus or anatomical aspects influencing percutaneous device selection [ 22 ], but also during the intra-operative and post-operative phases. During device delivery, TEE is critical in both LAAO-T and LAAO-P, with the widely accepted views at mid esophageal level in 0°, 45°, 90°, and 135° planes [ 20 , 22 ]. In LAAO-P, real-time TEE is also helpful for guiding interatrial septum puncture, and additional 3D multi-planar reconstruction is useful for adequate evaluation of the landing zone, measurement of 8–20% device compression, and assessment of a tight seal under concomitant fluoroscopic views and contrast angiography [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach

Branzoli

Guarracini

Marini

et al. 2021

JCM

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Background and Purpose: Left atrial appendage occlusion (LAAO) is an accepted therapeutic option for stroke prevention; however, the ideal technique and device have not yet been identified. In this study we evaluate the potential role of a heart team approach for patients contraindicated for oral anticoagulants and indicated for left atrial appendage closure, to minimize risk and optimize benefit in a patient-centered decision-making process. Methods: Forty patients were evaluated by the heart team for appendage occlusion. Variables considered were CHA2DS2VASc, HASBLED, documented blood transfusions, comorbidities, event forcing anticoagulant interruption, past medical history, anatomy of the left atrial appendage, and patient quality of life. Twenty patients had their appendage occluded percutaneously (65% male, mean age 72.3 ± 7.5, mean CHA2DS2VASc 4.2 ± 1.5, mean HASBLED 3.5 ± 1.1). The other twenty underwent thoracoscopic occlusion (65% male, mean age of 74.9 ± 8, mean CHA2DS2VASc 6.0 ± 1.5, HASBLED mean 5.4 ± 1.4). Percutaneous patients were on dual antiplatelet therapy for the first three months and aspirin thereafter, whereas the others received no anticoagulant/antiplatelet therapy from the day of surgery. Follow up included TEE, CT scan, and periodical clinical evaluation. Results: Mean duration of procedures and hospital stay were comparable. All patients had complete exclusion of the appendage; at a mean follow up of 33.1 ± 14.1 months, no neurological or hemorrhagic events were reported. Conclusions: A heart team approach may improve the decision-making process for stroke and hemorrhage prevention, where LAAO is a therapeutic option. Percutaneous and thoracoscopic appendage occlusion seem to be comparably safe and effective. An epicardial LAAO could be advisable in patients for whom the risk of bleeding is estimated as being too high for post-procedural antiplatelet therapy.

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Standalone Totally Thoracoscopic Left Appendage Clipping: Safe, Simple, Standardized

Cited by 8 publications

References 9 publications

Left Atrial Appendage Ligation Using the AtriClip Device: Single-Center Study of Device Safety and Efficacy

Left Atrial Appendage Ligation Using the AtriClip Device: Single-Center Study of Device Safety and Efficacy

Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective

Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach

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