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A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke

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Abstract

Objective

The present study evaluated the differences between left atrial appendage occlusion (LAAO) and left atrial appendage resection (LAAR) in terms of the safety and efficacy.

Materials and methods

From January 2018 to August 2022, 94 patients underwent a stand-alone LAAO, and 90 patients underwent stand-alone LAAR in our institution. All of these patients were included in this study. LAAO was performed via left mini-thoracotomy, and LAAR was performed via a left thoracoscopic approach. The patients’ characteristics and perioperative and postoperative data were obtained by retrospectively reviewing their medical records.

Results

The mean age of the patients was 72.4 ± 10.2 (LAAO) and 66.2 ± 9.4 (LAAR) years old (P < 0.05). There were no marked differences in the mean duration of atrial fibrillation (AF) or the ratio of AF type between both groups. The average CHA2DS2-Vasc scores were 4.4 ± 1.6 (LAAO) and 2.7 ± 1.8 (LAAR) (P < 0.05), and the average HAS-BLED scores were 2.9 ± 1.0 (LAAO) and 2.2 ± 1.2 (LAAR) (P < 0.05). The mean operation time was 49 ± 20 min (LAAO) and 34 ± 15 min (LAAR) (P < 0.05). No substantial gaps were detected in preoperative echo-graphic findings between the groups. No significant differences were observed in the amount of intraoperative or postoperative bleeding or the rate of intraoperative massive bleeding events between the groups. Successful LAA closure was achieved in all cases in both groups. Approximately 50% of patients underwent concomitant left pulmonary vein isolation (LPVI) during surgery, indicating no significant differences between the groups (P = 0.872). The early mortality rate was 1.04% in the LAAO group and 0% in the LAAR group (P = 0.132). There was no significant difference in the rate of postoperative LAA stump thrombus between the groups (8.5% in the LAAO group and 6.7% in the LAAR group; P = 0.320). The mean follow-up period was 851 ± 500 (6–1618) days in the LAAO group and 1208 ± 357 (49–1694) days in the LAAR group. Postoperative stroke events were detected in 1 patient in each group (P = 0.432). There was no significant difference in the sinus rhythm recovery rate after LPVI between these groups (31.1% in the LAAO group and 28.6% in the LAAR group; P = 0.763).

Conclusion

There were no significant differences between LAAO and LAAR in terms of the feasibility and the effectiveness as a method for stroke prophylaxis only to selected patients for both procedures, although further studies including the comparison between groups with the same backgrounds to confirm the authentic differences in the clinical results between these procedures.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, 1187-299, Kaname, Tsukuba, Ibaraki, 300-2622, Japan

    Akihiro Yoshimoto, Yoshihiro Suematsu, Kanan Kurahashi, Hidetomi Takahashi & Takafumi Inoue

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  1. Akihiro Yoshimoto
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  2. Yoshihiro Suematsu
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  3. Kanan Kurahashi
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  4. Hidetomi Takahashi
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  5. Takafumi Inoue
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Correspondence to Akihiro Yoshimoto.

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The authors declare no conflicts of interest in association with the present study.

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Supplementary file1 Video 1. The left atrial appendage (LAA) was exposed through pericardiotomy and the base of LAA was occluded with the AtriClip device (MP4 8723 KB)

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Yoshimoto, A., Suematsu, Y., Kurahashi, K. et al. A comparison between stand-alone left atrial appendage occlusion and resection as a method of preventing cardiogenic thromboembolic stroke. Gen Thorac Cardiovasc Surg 72, 157–163 (2024). https://doi.org/10.1007/s11748-023-01961-4

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  • DOI: https://doi.org/10.1007/s11748-023-01961-4

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