Epicardial standalone left atrial appendage clipping for prevention of ischemic stroke in patients with atrial fibrillation contraindicated for oral anticaogulation
| Autor: | Claudio Pomarolli, A. Graffigna, Massimiliano Marini, M. Fantinel, Roberto Bonmassari, Stefano Branzoli, C. Pederzolli, Mark La Meir, Giovanni D'Onghia, Francesco Corsini, Fabrizio Guarracini, Maurizio Centonze |
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| Přispěvatelé: | Faculty of Medicine and Pharmacy, Surgical clinical sciences, Cardiac Surgery |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Percutaneous hemorrhagic complication medicine.medical_treatment totally thoracoscopic surgery 030204 cardiovascular system & hematology Left atrial appendage occlusion Brain Ischemia surgery 03 medical and health sciences 0302 clinical medicine Left atrial Physiology (medical) Internal medicine Atrial Fibrillation Occlusion medicine Humans Atrial Appendage In patient 030212 general & internal medicine Aged Ischemic Stroke business.industry Anticoagulants Atrial fibrillation Clipping (medicine) medicine.disease Stroke ischemic stroke prevention Treatment Outcome Ischemic stroke Cardiology business Cardiology and Cardiovascular Medicine oral anticoagulation therapy Echocardiography Transesophageal |
| Popis: | Introduction The most appropriate treatment for stroke prevention in standalone atrial fibrillation patients with a high CHADS2VASC score contraindicated for oral anticoagulation (OAC) or novel OAC (NOAC) still needs to be defined. Percutaneous left atrial appendage (LAA) closure devices are available, but because of their endocardial positioning need a period of antiplatelet therapy (APT). This study aimed to evaluate the safety and efficacy of epicardial left atrial appendage clipping in patients contraindicated for (N)OAC and APT. Methods and results We describe a standalone totally thoracoscopic LAA clipping of forty-five consecutive patients with nonvalvular atrial fibrillation (NVAF; 32 males; age, 73.1 ± 7.4 years; CHADVASC, 6.5 ± 1.1; HAS-BLED 4.9 ± 0.9) with absolute contraindications to (N)OAC. The patients were selected by a multidisciplinary Heart Team. Sixty percent had a previous ischemic stroke and 51% a history of the hemorrhagic event and 22% both. All patients were implanted with an LAA epicardial clip, guided by preoperative computed tomography and intraoperative transesophageal echocardiography. The mean procedural duration was 52.3 ± 12.6 minutes with postprocedural extubation interval of 22.8 ± 14.6 minutes. No procedure-related complications occurred. Intraprocedural transesophageal echocardiography (TEE) showed complete LAA occlusion in all patients. At a mean follow-up of 16.4 ± 9.1 months (range, 2-34), with all patients off (N)OAC or APT, no ischemic stroke or hemorrhagic complications occurred. computed tomography or TEE at follow-up demonstrated a correct LAA occlusion in all with mean stumps of 3.3 ± 2.8 mm. Conclusion Thoracoscopic epicardial closure of the LAA with the AtriClip PRO2 device is a potentially safe and efficient treatment for stroke prevention in patients with NVAF contraindicated for anticoagulant therapy or APT. |
| Databáze: | OpenAIRE |
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