A Comparative Study of Thoracoscopic Left Atrial Appendage Clipping vs Stapled Resection

Area of Science:

• Cardiology
• Thoracic Surgery
• Medical Imaging

Background:

• The left atrial appendage (LAA) is a primary source of thrombus formation in atrial fibrillation (AF), increasing ischemic stroke risk.
• Effective LAA closure is vital for stroke prevention in AF patients.

Purpose of the Study:

• To compare the efficacy of LAA clipping versus stapled resection in achieving complete LAA closure.
• To evaluate the rates of complete LAA closure at one year post-procedure.

Main Methods:

• A thoracoscopic approach was used in 333 AF patients undergoing LAA closure.
• Propensity score matching (4:1) created comparable groups of 90 LAA clipping patients and 206 stapled resection patients.
• Complete LAA closure was defined as a residual LAA depth <1 cm on postoperative CT scans at 1 year.

Main Results:

• No 30-day mortality was observed.
• LAA clipping resulted in a significantly higher complete closure rate (95.6%) compared to stapled resection (83.0%, P=.003).
• Residual LAA stump depth was significantly shorter with clipping (2.9 mm) versus resection (5.3 mm, P=.001).

Conclusions:

• LAA clipping demonstrates superior rates of complete LAA closure compared to stapled resection.
• Monitoring patients with residual LAA stumps is critical due to potential links with thromboembolic events.
• Larger studies are warranted to confirm the impact of residual stumps on thromboembolic events.