Stand-Alone Thoracoscopic Left Atrial Appendage Closure in Nonvalvular Atrial Fibrillation Patients at High Bleeding...

Area of Science:

• Cardiology
• Minimally Invasive Surgery
• Thrombosis Management

Background:

• Nonvalvular atrial fibrillation (AF) patients at high bleeding risk often face contraindications for oral anticoagulants (OAC).
• Percutaneous left atrial appendage (LAA) closure is an option, but requires subsequent OAC or dual antiplatelet therapy.
• This poses a challenge for patients with absolute contraindications to antithrombotic treatment.

Purpose of the Study:

• To evaluate the efficacy and safety of thoracoscopic LAA closure as a standalone procedure.
• To assess outcomes in nonvalvular AF patients at high bleeding risk who cannot tolerate antithrombotic therapy.
• To determine if this technique avoids the need for postoperative OAC or dual antiplatelet treatment.

Main Methods:

• Twenty consecutive nonvalvular AF patients with high bleeding risk (mean HAS-BLED score 4.42) underwent thoracoscopic LAA closure using an epicardial clip device.
• The procedure was performed as a stand-alone intervention, with no subsequent OAC or antiplatelet therapy.
• Transesophageal echocardiography assessed complete LAA closure. Endpoints included closure success, operative complications, mortality, and 30-day/6-month adverse events.

Main Results:

• Complete LAA closure was achieved in all 20 patients.
• There were no operative complications or deaths related to the clip device.
• Follow-up demonstrated 95% freedom from postoperative complications and 100% freedom from cerebrovascular events, with an overall survival rate of 100%.

Conclusions:

• Thoracoscopic LAA closure is a viable alternative for nonvalvular AF patients at high bleeding risk (HAS-BLED >3).
• This technique effectively precludes the need for post-procedural antithrombotic therapy.
• External LAA clipping may reduce the risk of thromboembolic events compared to percutaneous methods.