Left Atrial Appendage Exclusion via Right Minithoracotomy Using an Epicardial Clip Device During Minimally Invasive...

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Procedures
• Electrophysiology

Background:

• Left atrial appendage (LAA) closure is recommended for atrial fibrillation (AF) patients to prevent stroke.
• Current minimally invasive techniques for LAA exclusion during mitral valve surgery are challenging.
• A novel epicardial clip device applied via right minithoracotomy is presented.

Purpose of the Study:

• To evaluate the feasibility and safety of a novel epicardial clip for LAA exclusion during minimally invasive mitral valve surgery.
• To assess the efficacy of this technique in preventing cardioembolic stroke in AF patients.
• To report the largest series of this specific LAA exclusion method.

Main Methods:

• 40 patients with AF undergoing minimally invasive mitral valve surgery via right minithoracotomy had concomitant LAA exclusion.
• An epicardial clip device was applied to the LAA base under direct vision after the intracardiac procedure.
• Successful closure was confirmed by intraoperative transesophageal echocardiography.

Main Results:

• 100% successful LAA clip deployment was achieved in all 40 patients.
• Mean operative, cardiopulmonary bypass, and cross-clamp times were recorded.
• In-hospital mortality was 0%; one patient had a stroke, and one required re-thoracotomy for bleeding.

Conclusions:

• Minimally invasive LAA exclusion using an epicardial clip via right minithoracotomy is feasible and safe.
• This technique achieves high deployment success rates without additional incisions.
• It offers a valuable stroke prevention strategy for AF patients undergoing minimally invasive valvular surgery.