The Effect of Minimally Invasive Thoracoscopic Left Atrial Appendage Excision on Cardiac Dynamic and Endocrine Function

Abstract

Purpose: Left atrial appendage (LAA) isolation is an effective surgical treatment for decreasing thromboembolic risk. We sought to evaluate the short-term effect of minimally invasive surgery with LAA excision on left atrial dynamic and endocrine function in atrial fibrillation (AF) patients. Methods: A total of 52 patients with paroxysmal AF undergoing minimally invasive surgery with LAA excision in Anzhen Hospital from October 2012 to June 2014 were enrolled in the study. The natriuretic peptide plasma level was determined by enzyme-linked immunosorbent assay (ELISA), and left atrial dynamic function was measured preprocedure by real-time three-dimensional echocardiography and postprocedure after 7 days and 3 months. Results: With the exception of six recurrences, 88.5% (46/52) of the patients were prospectively followed over 3 months in terms of their sinus rhythm postprocedure. No severe operative complications or embolism events occurred within those 3 months. Echocardiography showed a 3–6% decrease in left atrial volume postprocedure, and dynamic function was largely restored by 3 months. There was no significant change in natriuretic peptide levels, although a slight decrease was detected 7 days postprocedure, which gradually recovered by 3 months ( P = 0.350). Conclusions: There are no significant differences in left atrial dynamics and natriuretic peptide secretion in AF patients after minimally invasive surgery with LAA excision.

The Effects of Stand-alone Thoracoscopic Left Atrial Appendage Clipping on Blood Pressure and Electrolytes

“…the average serum sodium level decreased by 5.65 ± 2.61 mmol/L within 48 hours postprocedure, and there were 13 patients (61.9%) who decreased ≥ 4mmol/L, and 3 patients (14.29%) decreased ≥ 10 mmol/L. As a common postoperative complication, hyponatremia could induce severe central nervous system dysfunction including headache, nausea, lethargy, disorientation, or depressed re exes 20 .…”

“…Additionally, the cerebral edema induced by rapid and signi cant uctuations in serum sodium levels can lead to serious complications including seizures, coma, brain damage, and brain-stem herniation due to cerebral edema 20 . The predictable decline of serum sodium, we observed, secondary to the stand-alone thoracoscopic left atrial appendage clipping, could elucidate the early, unexplained postoperative serum sodium decline and may obviate further expensive and unnecessary investigation.…”

Exclusion of left atrial appendage: effects beyond thromboembolic prevention

“…These concentrations may or may not return to preprocedural level. Interestingly, in a recent study where LAA was surgically excised in 52 patients, plasma ANP levels were almost the same at 3 time points: preprocedure, 7 days and 3 months after procedure [9 ▪ ]. The discordancy between studies might be attributed to the different time points at which blood samples were collected.…”

“…In the following 30–45 days after LAAE, it seemed that LA would self-adjust in response to the modification of loading condition. Following LAA excision, changes in the LA size and function were similar: maximum LA volume and LA empty fraction significantly decreased 7 days after the procedure but returned to the preprocedural level in 3 months [9 ▪ ]. Two studies, both used 2D speckle tracking imaging technique, have shown that LA reservoir function improved at short-term follow-up after LAA closure [36,37].…”

Left atrial appendage occlusion: Percutaneous and surgical approaches in everyday practice

“…Two small studies indicated a slight rise in brain natriuretic peptide levels after transcatheter LAAO (32 patients together) [47,48]. On the other hand, there are several studies demonstrating that LAAO does not lead to any significant changes in natriuretic peptide levels at all [43,[49][50][51][52]. For instance, the abovementioned prospective randomized study PRAGUE-17 (400 patients) did not observe a difference in levels of natriuretic peptides between the LAAO and anticoagulated groups [53].…”