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Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation　-
Taisuke Nakayama1, Hiroshi Ito2, Shunsuke Sato3
1Department of Cardiovascular Surgery, Chiba-Nishi General Hospital Chiba Japan.
Insights
Thoracoscopic left atrial appendage occlusion (LAAO) is a safe and effective procedure for preventing stroke in patients with atrial fibrillation (AF). This study shows high success rates and low midterm adverse events, supporting LAAO as a viable treatment option.
Area of Science:
- Cardiology
- Minimally Invasive Surgery
- Stroke Prevention
Background:
- Atrial fibrillation (AF) significantly increases ischemic stroke risk, with most clots originating in the left atrial appendage (LAA).
- Thoracoscopic LAA occlusion (LAAO) offers a minimally invasive alternative to anticoagulation or endocardial devices, but multicenter data were limited.
Purpose of the Study:
- To evaluate the safety and efficacy of thoracoscopic LAAO in a multicenter Japanese registry.
- To assess procedural success, anatomic closure, and clinical outcomes, including cerebrovascular events and anticoagulant withdrawal.
Main Methods:
- The Totally Thoracoscopic Left Atrial Appendage Occlusion Study (TT-LAAOS) included 567 patients with nonvalvular AF undergoing thoracoscopic LAAO.
- Procedures utilized stapler excision or epicardial clip across 6 institutions from March 2018 to December 2024.
- Outcomes tracked included procedural success, closure rates, and long-term cerebrovascular events.
Main Results:
- Procedural success was 99.8% with no intraoperative deaths; 1.5% had residual stumps >10 mm.
- During 875.8 patient-years of follow-up, freedom from stroke or TIA was 99.5% (0.34/100 patient-years).
- Anticoagulants were discontinued in 63% of patients within 1 month post-procedure.
Conclusions:
- Thoracoscopic LAAO is a safe and effective method for stroke prevention in patients with AF.
- The procedure demonstrates high success rates, reliable LAA closure, and very low midterm thromboembolic events.
- This approach provides a valuable alternative for managing stroke risk in AF patients.
Background:
Atrial fibrillation (AF) is a major risk factor for ischemic stroke, with >90% of thrombi in nonvalvular AF originating in the left atrial appendage (LAA). Thoracoscopic LAA occlusion (LAAO), with or without ablation, is a minimally invasive alternative to endocardial devices or anticoagulation, but multicenter data are limited.
Methods And Results:
The Totally Thoracoscopic Left Atrial Appendage Occlusion Study (TT-LAAOS) is a multicenter Japanese registry of thoracoscopic LAAO in nonvalvular AF. From March 2018 to December 2024, 567 patients underwent the procedure at 6 institutions using stapler excision or epicardial clip. Outcomes included procedural success, anatomic closure, cerebrovascular events, and anticoagulant withdrawal. Mean age was 72 years; 63.5% had long-standing persistent AF. Median CHADS2 and CHA2DS2 VASc scores were 2 and 4, respectively. Success was 99.8% with no intraoperative deaths; residual stumps >10 mm were found in 1.5%. At discharge, sinus rhythm was present in 45%. Anticoagulants were stopped in 15% immediately and 63% within 1 month. During 875.8 patient years of follow-up (median 13 months), freedom from stroke or transient ischemic attack was 99.5% (0.34/100 patient years), with no thromboembolic deaths.
Conclusions:
Thoracoscopic LAAO, with or without ablation, is safe and effective for stroke prevention in AF, with high success, reliable closure, and very low midterm events.
