Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation...

Area of Science:

• Cardiology
• Thoracic Surgery
• Medical Devices

Background:

• Left atrial appendage (LAA) is a primary source of thrombi in atrial fibrillation (AF) patients.
• The impact of Totally Thoracoscopic (TT)-LAA exclusion on left atrial (LA) function is not well understood.
• Epicardial clip exclusion is a minimally invasive technique for LAA management.

Purpose of the Study:

• To evaluate the effect of TT-LAA exclusion using an epicardial clip on left atrial (LA) function.
• To assess the safety and functional outcomes of TT-LAA exclusion in AF patients.
• To determine the short-term and mid-term changes in LA function after LAA exclusion.

Main Methods:

• A cohort of 26 AF patients with contraindications to oral anticoagulation underwent standalone TT-LAA exclusion with a clip device.
• Preoperative assessments included 3D CT, trans-esophageal echocardiography, spirometry, and cerebrovascular Doppler ultrasound.
• Left atrial function was evaluated using transthoracic echocardiography and 2D strain analysis at baseline, discharge, and 3-month follow-up.

Main Results:

• The procedure was performed safely with no major complications.
• Left atrial reservoir function significantly decreased at discharge but recovered by 3 months post-procedure.
• NT-proBNP levels increased post-procedure, returning to baseline at 3 months, while E/A changes persisted.

Conclusions:

• TT-LAA exclusion with an epicardial clip appears to be a safe procedure concerning atrial function.
• LAA amputation temporarily impairs LA reservoir function, with recovery observed over time.
• This minimally invasive approach offers a viable option for LAA management in select AF patients.