Thoracoscopic Left Atrial Appendage Clipping: A Multicenter Cohort Analysis.

Area of Science:

• Cardiology
• Thoracic Surgery
• Medical Devices

Background:

• The left atrial appendage (LAA) is a primary source of stroke in patients with atrial fibrillation.
• Thoracoscopic clipping offers a potentially durable and safe LAA closure technique.

Purpose of the Study:

• To evaluate the closure rate, safety, and stroke rate following thoracoscopic LAA clipping.
• To assess the efficacy of LAA clipping as part of a thoracoscopic maze procedure.

Main Methods:

• A study of 222 consecutive patients undergoing thoracoscopic LAA clipping from 2012 to 2016 across 4 centers.
• LAA closure completeness assessed by CT or transesophageal echocardiography.
• Primary outcome: complete LAA closure; secondary outcomes: complications, cerebrovascular events, and mortality.

Main Results:

• Complete LAA closure was achieved in 95.0% of patients.
• High safety profile with 96.4% freedom from 30-day complications and 98.6% overall survival.
• Low rate of cerebrovascular events (0.5 per 100 patient-years) after a median follow-up of 20 months.

Conclusions:

• Thoracoscopic LAA clipping is a feasible and safe technique for LAA closure in atrial fibrillation patients.
• The low rate of cerebrovascular events is likely due to LAA closure, anticoagulation, and rhythm control.