First Results of a Surgical Standalone Left Atrial Appendage Management Program in Germany

Objectives: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia with an incidence of 1.5 to 2.0% and is associated with an increased risk of thromboembolism from the left atrial appendage (LAA) with recurrent cerebral ischemia. If patients are not suitable for oral anticoagulation due to bleeding complications, an epicardial minimal invasive surgical occlusion of the LAA is feasible. We present our first results of a newly and nationwide unique surgical left atrial appendage management (LAAM) program.

Methods: Thirty-nine patients (16 females [41.0%], mean age: 75.8 years) have been treated with an isolated standalone left atrial appendage occlusion surgery. LAAM was performed in all patients with a clip device. Mean CHA₂DS-VASC score was 4.4 ± 1.5, mean HAS-BLED score 3.9 ± 1.1. A paroxysmal AF was detected in 13 (33.3%) patients, a persistent AF in 12 (30.7%) patients and a long-lasting persistent AF in 14 (36.0%) patients.

First series of procedures were performed via left sided minimal thoracotomy 29 (74.3%), after gaining procedural comfort, 9 (23.1%) patients were treated thoracoscopically. One emergency patient after catheter-based LAA perforation (2.6%) was treated via median sternotomy.

Result: No patient suffered a stroke or a transient ischemic attack postoperatively. One (2.6%) major bleeding and 2 (5.2%) rethoracotomies occurred postoperatively (thoracotomy group). No minor or major bleeding occurred in the endoscopic LAAM group. One (2.6%) patients died due to preprocedural existing embolic intestinal ischemia. At discharge all patients were off oral anticoagulation. Nine (23.1%) patients continued to take antiplatelet drugs due to preexisting coronary artery disease.

Conclusion: A minimally invasive surgical epicardial occlusion of the left atrial appendage is a safe and feasible option for LAA closure in patients with a contraindication for oral anticoagulation, especially with respect to neurological outcome. An endoscopic LAAM approach implies a high success rate without MACCE occurrence. For final judgment, larger studies with longer follow-up are warranted.

Publication History

Article published online:
19 February 2021