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Ghinescu M, Franke UFW, Ortega M, Hüther F, Rufa MI, Göbel N. Concomitant intra-atrial excision of the left atrial appendage during robotic-assisted minimally invasive cardiac surgery. Front Cardiovasc Med 2023; 10:1074777. [PMID: 36937917 PMCID: PMC10017964 DOI: 10.3389/fcvm.2023.1074777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Objective Surgical closure of the left atrial appendage (LAA) in patients with atrial fibrillation undergoing cardiac surgery can decrease the risk of stroke and thromboembolism and should therefore be considered. In minimally invasive, thoracoscopic, or robotic-assisted mitral valve surgery, however, external procedures such as clip application or epicardial resection are not feasible due to anatomic limitations and the reduced size of the access port. Internal suture closing techniques bear the risk of recurrent LAA reperfusion, so far. We present a novel surgical technique of LAA excision and subsequent defect closure from the interior aspect of the atrium. Methods We developed this novel technique during robotic-assisted cardiac surgeries. In short, the LAA is invaginated into the left atrium, excised completely at the base using scissors and the stump is then closed from the inside with a two-layer looped PTFE suture. We give a detailed step-by-step description of the technique. Results A total of 20 patients received intra-atrial LAA excision so far. Complete resection of the LAA without any residual stump or bleeding was achieved in all cases. There were no procedure-related complications. Conclusion The intra-atrial LAA excision technique shows promising preliminary results regarding efficacy, safety, and reproducibility during robotic-assisted cardiac operations and could be recommended for all right-sided minimally invasive cardiac surgical procedures.
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Domínguez H, Madsen CV, Westh ONH, Pallesen PA, Carrranza CL, Irmukhamedov A, Park-Hansen J. Does Left Atrial Appendage Amputation During Routine Cardiac Surgery Reduce Future Atrial Fibrillation and Stroke? Curr Cardiol Rep 2018; 20:99. [PMID: 30171381 PMCID: PMC6132740 DOI: 10.1007/s11886-018-1033-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose of Review Stroke is the most feared complication of atrial fibrillation. To prevent stroke, left atrial appendage exclusion has been targeted, as it is the prevalent site for formation of heart thrombi during atrial fibrillation. We review the historic development of methods for exclusion of the left atrial appendage and the evidence to support its amputation during routine cardiac surgery. Recent Findings Evidence is not yet sufficient to routinely recommend left atrial exclusion during heart surgery, despite a high prevalence of postoperative atrial fibrillation. Observational studies indicate that electrical isolation of scarring from clip or suture techniques reduces the arrhythmogenic substrate. Summary Randomized studies comparing different methods of closure of the left atrial appendage before amputation do not exist. Such studies are therefore warranted, as well as studies that can elucidate whether amputation is superior to leaving the left atrial appendage stump. Potentially, thrombogenic remaining pouch after closure should be addressed.
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Affiliation(s)
- Helena Domínguez
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark. .,Department of Biomedicine, University of Copenhagen, Blegdamsvej 3B, Panum Building 10.5, DK-2400, Copenhagen, Denmark.
| | - Christoffer Valdorff Madsen
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark
| | - Oliver Nøhr Hjorth Westh
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark
| | - Peter Appel Pallesen
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark
| | - Christian Lildal Carrranza
- Department of Cardio-thoracic Surgery, Blegdamsvej 9, 2100 København, Copenhagen, Rigshospitalet, Denmark
| | - Akhmadjon Irmukhamedov
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark
| | - Jesper Park-Hansen
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Nordre Fasanvej 57, vej 4, Building 3, 3rd Floor, DK-2000, Frederiksberg, Denmark.,Department of Biomedicine, University of Copenhagen, Blegdamsvej 3B, Panum Building 10.5, DK-2400, Copenhagen, Denmark
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