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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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[Left atrial appendage in rheumatic mitral valve disease: The main source of embolism in atrial fibrillation]

Ovidio A García-Villarreal1, José A Heredia-Delgado1

  • 1Departamento de Cirugía Cardiaca, Hospital de Cardiología UMAE 34, Instituto Mexicano del Seguro Social, , Monterrey, Nuevo León, México.

Archivos De Cardiologia De Mexico
|December 18, 2016
PubMed

Insights

Surgical removal of the left atrial appendage in patients with rheumatic mitral valve disease and persistent atrial fibrillation may eliminate stroke risk and the need for anticoagulation. This procedure targets a potential source of emboli, improving patient outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Vascular Surgery

Background:

  • Rheumatic mitral valve disease (RMVD) and persistent atrial fibrillation (AF) increase stroke risk.
  • The left atrial appendage (LAA) is a potential source of thromboembolism in AF patients.
  • Long-term oral anticoagulation is often required but carries bleeding risks.

Purpose of the Study:

  • To evaluate the efficacy of LAA resection in reducing stroke incidence in RMVD patients with persistent AF.
  • To assess the feasibility of discontinuing oral anticoagulation post-LAA resection.
  • To investigate the association between LAA thrombi and embolic events.

Main Methods:

  • A prospective observational study of 27 adult patients undergoing mitral valve surgery and LAA resection.
  • Oral anticoagulation was ceased 3 months post-surgery.
  • Outcomes included absence of embolic stroke and assessment of postoperative LAA embolism via echocardiography.

Main Results:

  • No embolic strokes occurred after 3 months post-surgery.
  • One transient ischemic attack (TIA) occurred while on warfarin pre-operatively.
  • Pre-operative LAA thrombi were identified in 40.7% of patients, with 54.5% of these having a history of embolic stroke.

Conclusions:

  • LAA resection may be a primary strategy to prevent stroke in RMVD patients with persistent AF.
  • Eliminating the LAA could negate the need for long-term anticoagulation.
  • The LAA is a significant source of emboli in this patient population.
Abstract

Keywords:
Atrial appendageAtrial fibrillationAtrial thrombusEnfermedad reumática cardiacaFibrilación auricularMexicoMitral valveMéxicoOrejuelaRheumatic heart diseaseTrombo auricularVálvula mitral

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