scholarly journals Angiographic Efficacy of the Atriclip Left Atrial Appendage Exclusion Device Placed by Minimally Invasive Thoracoscopic Approach

2017 ◽  
Vol 3 (12) ◽  
pp. 1356-1365 ◽  
Author(s):  
Christopher R. Ellis ◽  
Sam G. Aznaurov ◽  
Neel J. Patel ◽  
Jennifer R. Williams ◽  
Kim Lori Sandler ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Thoracoscopic Approach

Abstract TP417: Minimally-Invasive Video-Assisted Ligation of Left Atrial Appendage in Atrial Fibrillation: Stroke Prevention Strategy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Basel Ramlawi ◽  
Kareem Bedeir ◽  
Luis Garcia-Morales ◽  
John Volpi ◽  
Mahesh Ramchandani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Minimally Invasive ◽  
Stroke Prevention ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Average Length ◽  
Prevention Strategy ◽  
Atrial Appendage ◽  
Thoracoscopic Approach ◽  
Video Assisted

Background: Non-valvular atrial fibrillation (AF) is a leading cause of embolic stroke, especially in the elderly population. The vast majority of thrombo-emboli in AF patients originate within the left atrial appendage (LAA). Effective and complete isolation of the LAA has been demonstrated to have a similar stroke-reduction effect as chronic anticoagulation. This study presents our initial experience with a novel minimally-invasive video-assisted (MIVA) thoracoscopic approach to epicardially isolate the LAA using the AtriClip device. Methods: Six consecutive AF patients (mean age 73.6 years, 3 of 6 male) with contra-indication to systemic anticoagulation underwent epicardial ligation of LAA using the AtriClip device. Procedure involved two 5mm ports and one 15mm port with application of the device at the base of the LAA under direct visualization. Immediate intra-operative confirmation of LAA isolation via trans-esophageal echocardiography (TEE) was obtained. Anticoagulation was not restarted post-operatively. Results: Average procedure length was 43mins and average length of stay was 72hours. All six patients had a non-complicated post-operative course. No stroke, myocardial infarction, renal failure or re-operation was encountered. No transfusions were needed. All patients were extubated in the operating room at conclusion of procedure and were ambulatory on the first postoperative day. 3 of 6 patients experienced excessive pleural drainage lasting 2-4 days postoperatively. TEE confirmation of complete LAA obliteration was achieved in all patients. Conclusions: MIVA LAA ligation appears to be a safe, effective and simple procedure to isolate the LAA in AF patients with contra-indication to anticoagulation. A multi-institutional trial to assess the efficacy of MIVA LAA ligation as a stroke prevention strategy is warranted and forthcoming.

Surgical Treatment of Isolated (Lone) Atrial Fibrillation with Gemini-S Ablation and Left Atrial Appendage Excision (GALAXY Procedure)

2012 ◽  
Vol 7 (1) ◽  
pp. 33-38 ◽  
Author(s):  
John R. Doty ◽  
Stephen E. Clayson
Keyword(s):  
Atrial Fibrillation ◽  
Minimally Invasive ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Persistent Atrial Fibrillation ◽  
Atrial Appendage ◽  
Lone Atrial Fibrillation ◽  
Surgical Ablation ◽  
Invasive Approach ◽  
The Galaxy

Objective Surgical ablation with radiofrequency is a safe and effective treatment for atrial fibrillation. Recent advances in instrumentation have allowed for the application of bipolar radiofrequency through a minimally invasive approach using small bilateral thoracotomies for pulmonary vein isolation, destruction of autonomic ganglia, and excision of the left atrial appendage (GALAXY procedure). Methods Thirty-two patients underwent surgical ablation of atrial fibrillation with the GALAXY procedure over a 43-month period. Data were collected in a prospective manner during hospitalization and at 1-, 3-, 6-, and 12-month intervals for rhythm, medications, and subsequent interventions. Results There were no operative mortality, no myocardial infarction, and no stroke. One patient required reexploration for bleeding. Mean follow-up was 28 months (range, 4–43 months). Freedom from atrial fibrillation at 12 and 24 months, respectively, was 90% and 67% for patients with paroxysmal fibrillation and 80% and 63% for patients with persistent atrial fibrillation. Of the patients who were not in sinus rhythm, four reverted to atrial fibrillation and two reverted to atrial flutter. Conclusions The GALAXY procedure is a safe and effective, minimally invasive method for treatment of isolated (lone) atrial fibrillation. The operation provides excellent short-term freedom from atrial fibrillation and should be considered in patients with isolated paroxysmal atrial fibrillation.

Left Atrial Appendage Occlusion Pilot Study of a Fourth-Generation, Minimally Invasive Device

2012 ◽  
Vol 7 (3) ◽  
pp. 195-200 ◽  
Author(s):  
Hideyuki Fumoto ◽  
A. Marc Gillinov ◽  
Roberto M. Saraiva ◽  
Tetsuya Horai ◽  
Tomohiro Anzai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Angiography ◽  
Minimally Invasive ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Therapeutic Option ◽  
Median Sternotomy ◽  
Atrial Appendage ◽  
Fourth Generation ◽  
Left Circumflex Artery

Objective Exclusion of the left atrial appendage is proposed to reduce the risk of stroke in patients with atrial fibrillation. The aim of this study was to evaluate the feasibility and efficacy of a fourth-generation atrial exclusion device developed for minimally invasive applications. Methods The novel atrial exclusion device consists of two polymer beams and two elastomeric bands that connect the two beams at either end. Fifteen mongrel dogs were implanted with the device at the base of the left atrial appendage through a median sternotomy and were evaluated at 30 (n = 7), 90 (n = 6), and 180 (n = 2) days after implantation by epicardial echocardiography, left atrial and coronary angiography, gross pathology, and histology. Results Left atrial appendage exclusion was completed without hemodynamic instability. Coronary angiography revealed that the left circumflex artery was patent in all cases. A new endothelial tissue layer developed, as expected, on the occluded orifice of the left atrium. Conclusions This novel atrial exclusion device achieved easy, reliable, and safe exclusion of the left atrial appendage, with favorable histological results in a canine model for up to 6 months. Clinical application could provide a new therapeutic option for reducing the risk of stroke in patients with atrial fibrillation.

Initial Experience with Minimally Invasive Surgical Exclusion of the Left Atrial Appendage with an Epicardial Clip

2017 ◽  
Vol 12 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Nathan E. Smith ◽  
Jeevan Joseph ◽  
John Morgan ◽  
Saqib Masroor
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Minimally Invasive ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Intercostal Space ◽  
Atrial Appendage ◽  
Maze Procedure ◽  
Initial Experience ◽  
The Mean

Objective Atrial fibrillation (AF) is the primary cardiac abnormality associated with ischemic stroke. Atrial fibrillation affects 2.7 million people with a stroke rate of 3.5% per year. Most of the emboli in patients with nonvalvular AF originate in the left atrial appendage (LAA). Surgical exclusion of the LAA decreases the yearly risk of stroke to 0.7% when combined with a Maze procedure. Traditional oversewing the LAA from inside the left atrium is associated with a significant number of recanalizations of LAA. An alternate technique is epicardial clipping, which has been approved through sternotomy for permanent exclusion of LAA. We present our initial experience of epicardial clipping of the LAA using a minimally invasive approach. Methods Between May 2012 and December 2015, a total of 24 consecutive patients underwent minimally invasive, echo-guided epicardial clipping. Indications for the procedure were persistent (n = 12) or paroxysmal (n = 12) AF in patients who could not tolerate full anticoagulation because of a combination of gastrointestinal bleeding (n = 7), hemorrhagic stroke (n = 5), ischemic stroke (n = 5), intramuscular bleeding (n = 3), falls (n = 2), urinary tract bleeding (n = 2), subdural hematoma (n = 1), traumatic aortic intramural hematoma (n = 1), and lifestyle and career practices inconsistent with anticoagulation (n = 1). The clipping was performed through three 5-mm ports in the left seventh intercostal space (n = 22) or a 5-cm incision in the fifth intercostal space (n = 2). Echocardiography was performed to exclude the presence of LAA thrombus and to confirm exclusion of LAA before final deployment of the clip. Results The mean age was 73.6 years. The mean CHA2DS2VASC score was 4.7 and the mean HAS-BLED score was 3.8. The mean postoperative length of stay was 6.4 days. One patient died of stroke-related complications 10 days after successful clipping, and two patients required thoracentesis to drain recurrent pleural effusions. All patients had successful exclusion of LAA defined as residual sac of less than 1 cm. Conclusions Isolated epicardial left atrial clipping is a safe treatment option in high-risk patients with AF. Long-term success in preventing stroke is still to be determined, but short-term results are very encouraging.

New Approach to Exclude the Left Atrial Appendage during Minimally Invasive Cryothermic Surgical Ablation

2015 ◽  
Vol 10 (5) ◽  
pp. 323-327 ◽  
Author(s):  
Niv Ad ◽  
Paul S. Massimiano ◽  
Deborah J. Shuman ◽  
Graciela Pritchard ◽  
Sari D. Holmes
Keyword(s):  
Minimally Invasive ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Transverse Sinus ◽  
Current Approach ◽  
Atrial Appendage ◽  
Perioperative Outcomes ◽  
Surgical Ablation ◽  
New Approach ◽  
Increased Risk

Objective Atrial fibrillation (AF) is associated with an increased risk for embolic stroke originating from the left atrial appendage (LAA). A recently introduced LAA epicardial clip occluder, the AtriClip PRO, can be applied through midsternotomy or small thoracotomy. We assessed the safety and efficacy of a new surgical approach to apply the AtriClip PRO and exclude the LAA through right minithoracotomy and transverse sinus. Methods The AtriClip PRO was applied in 24 patients with the new approach. Intraoperative transesophageal echocardiography was used to exclude LAA thrombi at baseline and evaluate LAA perfusion and residual neck postoperatively. Results Mean (SD) age was 64.5 (8.6) years; 95% of the patients had nonparoxysmal AF with median AF duration of 39 months (interquartile range, 9.3–85.3 months), and mean (SD) left atrium diameter was 4.5 (0.7) cm (range, 3.1–5.7 cm). In one attempt, the clip was not deployed because of severe adhesions in the transverse sinus area. The procedural success rate was 95%. Nine minimally invasive mitral valve repairs were combined with surgical ablation; the rest were isolated right minithoracotomy Cox maze procedures. There was no remaining LAA neck in 71% of the patients. Perioperative outcomes were acceptable, and median length of stay was 5.5 days. Conclusions The development of a reliable approach to LAA management during minimally invasive surgical ablation through right minithoracotomy has been challenging. This new approach is safe and effective and should offer a superior and consistent early and long-term solution compared with the current approach of endocardial stitch closure.

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