Thoracoscopic left atrial appendectomy and thoracic endovascular aortic repair (TEVAR) in a patient with cardiogenic stroke combined with acute aortic dissection

Early and Middle-Term Results and Anticoagulation Strategy after Left Atrial Appendage Exclusion Using an Epicardial Clip Device

Objective: The present study aimed to evaluate short- and middle-term results and postoperative anticoagulation of left atrial appendage (LAA) exclusion with an epicardial clip device.

Materials and Methods: From September 2017 to August 2019, 102 patients at our institution underwent epicardial LAA exclusion using the AtriClip device. Anticoagulation therapy was resumed in the very early postoperative period and continued for at least three months after surgery. The patients’ data were obtained by reviewing their medical records retrospectively.

Results: The mean and median durations of follow-up was 510 ± 184 days and 482 days (range, 216–938 days), respectively. Successful LAA exclusion was confirmed in all but one patient. No device-related complications occurred during surgery. Postoperative computed tomography (CT) findings revealed no migration or displacement of the clips in any patient; however, small clots were observed at the LAA stump in seven patients. Stroke-free rate during the follow-up period was 98.9%.

Conclusion: LAA exclusion using the AtriClip device was a feasible treatment method in terms of its early and middle-term safety and efficacy. In addition, our postoperative anticoagulation strategy could be optimal for maximizing the procedure’s merits, although further studies, involving a larger number of patients and longer duration of follow-up, are needed.