Analysis of the effect of totally thoracoscopic versus thoracoscopic-assisted minimally invasive small incision surgery in left atrial appendage clipping_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 YAO Qing , YE Cong , LIU Fei , MA Hao , XU Dong

Department of Cardiac and Vascular Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China;

Corresponding author：

YAO Qing, Email: 1983yaoqing@163.com

Keywords：

Totally thoracoscopic; thoracoscopic-assisted; left atrial appendage clipping; minimally invasive

DOI：

10.7507/1007-4848.202203049

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the surgical effects of totally thoracoscopic and thoracoscopic-assisted small incision for left atrial appendage clipping. Methods The clinical data of patients who underwent left atrial appendage clipping surgery via totally thoracoscopy or thoracoscopic-assisted minimally invasive small incision from November 2018 to March 2022 in Beijing Tiantan Hospital were retrospectively analyzed. According to the surgical approach, they were divided into a totally thoracoscopic group and a small incision group. The clinical results were compared between the two groups. Results A totoal of 41 patients were enrolled, including 30 males and 11 females, with an average age of 66.6±6.1 years. There were 23 patients in the totally thoracoscopic group and 18 patients in the small incision group. The CHA₂DS₂-VASc score was 4.5±1.1 points, and HAS-BLED score was 3.7±1.5 points. No death occured in the whole group. There was no statistical difference between the two groups in terms of operation time, chest complications, successful rate of closure of the left atrial appendage, residual length of the left atrial appendage, or displacement of the atrial appendage clip (P>0.05). The total drainage volume in the totally thoracoscopic group was less than that in the small incision group, and the difference was statistically significant (P=0.031). The median follow-up time was 10 (1-30) months, during which there was 1 patient of stroke and 1 patient of left atrial thrombus in both groups. Conclusion Totally thoracoscopic left atrial appendage clipping is less invasive than thoracoscopic-assisted minimally invasive small incision surgery and does not increase the risk of surgical complications.

Citation： YAO Qing, YE Cong, LIU Fei, MA Hao, XU Dong. Analysis of the effect of totally thoracoscopic versus thoracoscopic-assisted minimally invasive small incision surgery in left atrial appendage clipping. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(12): 1709-1713. doi: 10.7507/1007-4848.202203049 Copy

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2.	刘佳琦, 芦颜美. 心房颤动左心耳血栓形成解剖机制特点及左心耳血栓的防治进展. 医学综述, 2021, 27(20): 4046-4051.
3.	Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: An update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J, 2012, 33(21): 2719-2747.
4.	王鹏, 戴海龙, 光雪峰. 房颤抗凝治疗进展. 中国心血管病研究, 2017, 15(3): 200-204.
5.	Katsanos AH, Kamel H, Healey JS, et al. Stroke prevention in atrial fibrillation: Looking forward. Circulation, 2020, 142(24): 2371-2388.
6.	Agarwal S, Hachamovitch R, Menon V. Current trial-associated outcomes with warfarin in prevention of stroke in patients with nonvalvular atrial fibrillation: A meta-analysis. Arch Intern Med, 2012, 172(8): 623-631.
7.	Katz ES, Tsiamtsiouris T, Applebaum RM, et al. Surgical left atrial appendage ligation is frequently incomplete: A transesophageal echocardiograhic study. J Am Coll Cardiol, 2000, 36(2): 468-471.
8.	Rosati F, de Maat GE, Valente MAE, et al. Surgical clip closure of the left atrial appendage. J Cardiovasc Electrophysiol, 2021, 32(10): 2865-2872.
9.	Page S, Hallam J, Pradhan N, et al. Left atrial appendage exclusion using the AtriClip device: A case series. Heart Lung Circ, 2019, 28(3): 430-435.
10.	Whitlock RP, Belley-Cote EP, Paparella D, et al. Left atrial appendage occlusion during cardiac surgery to prevent stroke. N Engl J Med, 2021, 384(22): 2081-2091.
11.	姜兆磊, 汤敏, 梅举, 等. 高龄冠心病合并心房颤动患者行非体外循环冠状动脉旁路移植术中左心耳处理的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(2): 186-190.
12.	Sunagawa G, Karimov JH, Breitbach M, et al. Impact of a refined advanced design for left atrial appendage exclusion. Eur J Cardiothorac Surg, 2017, 52(6): 1098-1103.
13.	Yoshimoto A, Suematsu Y, Kurahashi K, et al. Early and middle-term results and anticoagulation strategy after left atrial appendage exclusion using an epicardial clip device. Ann Thorac Cardiovasc Surg, 2021, 27(3): 185-190.
14.	Bedeir K, Warriner S, Kofsky E, et al. Left atrial appendage epicardial clip (AtriClip): Essentials and post-procedure management. J Atr Fibrillation, 2019, 11(6): 2087.
15.	Branzoli S, Marini M, Guarracini F, et al. Epicardial standalone left atrial appendage clipping for prevention of ischemic stroke in patients with atrial fibrillation contraindicated for oral anticaogulation. J Cardiovasc Electrophysiol, 2020, 31(8): 2187-2191.

1. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 2021, 42(5): 373-498.
2. 刘佳琦, 芦颜美. 心房颤动左心耳血栓形成解剖机制特点及左心耳血栓的防治进展. 医学综述, 2021, 27(20): 4046-4051.
3. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: An update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J, 2012, 33(21): 2719-2747.
4. 王鹏, 戴海龙, 光雪峰. 房颤抗凝治疗进展. 中国心血管病研究, 2017, 15(3): 200-204.
5. Katsanos AH, Kamel H, Healey JS, et al. Stroke prevention in atrial fibrillation: Looking forward. Circulation, 2020, 142(24): 2371-2388.
6. Agarwal S, Hachamovitch R, Menon V. Current trial-associated outcomes with warfarin in prevention of stroke in patients with nonvalvular atrial fibrillation: A meta-analysis. Arch Intern Med, 2012, 172(8): 623-631.
7. Katz ES, Tsiamtsiouris T, Applebaum RM, et al. Surgical left atrial appendage ligation is frequently incomplete: A transesophageal echocardiograhic study. J Am Coll Cardiol, 2000, 36(2): 468-471.
8. Rosati F, de Maat GE, Valente MAE, et al. Surgical clip closure of the left atrial appendage. J Cardiovasc Electrophysiol, 2021, 32(10): 2865-2872.
9. Page S, Hallam J, Pradhan N, et al. Left atrial appendage exclusion using the AtriClip device: A case series. Heart Lung Circ, 2019, 28(3): 430-435.
10. Whitlock RP, Belley-Cote EP, Paparella D, et al. Left atrial appendage occlusion during cardiac surgery to prevent stroke. N Engl J Med, 2021, 384(22): 2081-2091.
11. 姜兆磊, 汤敏, 梅举, 等. 高龄冠心病合并心房颤动患者行非体外循环冠状动脉旁路移植术中左心耳处理的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(2): 186-190.
12. Sunagawa G, Karimov JH, Breitbach M, et al. Impact of a refined advanced design for left atrial appendage exclusion. Eur J Cardiothorac Surg, 2017, 52(6): 1098-1103.
13. Yoshimoto A, Suematsu Y, Kurahashi K, et al. Early and middle-term results and anticoagulation strategy after left atrial appendage exclusion using an epicardial clip device. Ann Thorac Cardiovasc Surg, 2021, 27(3): 185-190.
14. Bedeir K, Warriner S, Kofsky E, et al. Left atrial appendage epicardial clip (AtriClip): Essentials and post-procedure management. J Atr Fibrillation, 2019, 11(6): 2087.
15. Branzoli S, Marini M, Guarracini F, et al. Epicardial standalone left atrial appendage clipping for prevention of ischemic stroke in patients with atrial fibrillation contraindicated for oral anticaogulation. J Cardiovasc Electrophysiol, 2020, 31(8): 2187-2191.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of the effect of totally thoracoscopic versus thoracoscopic-assisted minimally invasive small incision surgery in left atrial appendage clipping

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