Endocardial obliterative left atrial appendage closure by inverted purse-string plication

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Interventional Cardiology

Background:

• Left atrial appendage closure (LAAC) is crucial for stroke prevention in patients with atrial fibrillation.
• Existing surgical LAAC techniques may have limitations in achieving complete obliteration.
• Minimally invasive and robotic mitral surgery offer advantages but require effective concomitant LAAC strategies.

Purpose of the Study:

• To describe and evaluate a novel endocardial obliterative LAAC technique.
• To assess the safety and efficacy of this technique in patients undergoing minimally invasive or robotic mitral surgery.
• To determine the anatomic and clinical outcomes of this combined surgical approach.

Main Methods:

• A retrospective analysis of patients undergoing robotic mitral valve surgery or ASD repair with tricuspid intervention and concomitant endocardial obliterative LAAC.
• The technique involves inverting the LAA, purse-string plication, and 2-layer orifice closure.
• Pre- and postoperative ECG-gated cardiac CT (ECG-CT) was used to assess LAA closure.

Main Results:

• Twenty-four patients underwent the procedure with no conversions or intraoperative bleeding.
• No perioperative deaths, strokes, or major adverse events were reported.
• 3-6 month ECG-CT demonstrated complete LAAC in all patients, with no contrast inflow or complications.

Conclusions:

• Endocardial obliterative LAAC with inverted purse-string plication is a simple, safe, and effective adjunct to minimally invasive mitral surgery.
• This technique achieves complete anatomic closure, potentially improving stroke prevention.
• The method is inexpensive and shows promising results in this early series.