Left Atrial Appendage Resection during Minimally Invasive Aortic Valve Surgery via Right Minithoracotomy

2017 ◽  
Vol 12 (5) ◽  
pp. 378-379 ◽  
Author(s):  
Nobuo Kondo ◽  
Toshinori Totsugawa ◽  
Arudo Hiraoka ◽  
Kentaro Tamura ◽  
Hidenori Yoshitaka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Minimally Invasive ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Transverse Sinus ◽  
Atrial Appendage ◽  
Surgical Stapling ◽  
Stapling Device ◽  
Anterolateral Thoracotomy ◽  
Feasible Option

Here, we report concomitant resection of the left atrial appendage through the transverse sinus during minimally invasive aortic valve replacement via right anterolateral thoracotomy. The left atrial appendage was exposed by raising the collapsed ascending aorta and was safely resected using a surgical stapling device. This procedure is a feasible option in elderly patients, for whom a percutaneous procedure would be inappropriate, and could be useful for preventing thromboembolic and hemorrhagic complications.

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.

Left Atrial Appendage Resection during Minimally Invasive Aortic Valve Surgery via Right Minithoracotomy

2017 ◽  
Vol 12 (5) ◽  
pp. 378-379
Author(s):  
Nobuo Kondo ◽  
Toshinori Totsugawa ◽  
Arudo Hiraoka ◽  
Kentaro Tamura ◽  
Hidenori Yoshitaka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Minimally Invasive ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Valve Surgery ◽  
Atrial Appendage ◽  
Aortic Valve Surgery

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

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.

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