Cor Vasa 2017, 59(4):e376-e380 | DOI: 10.1016/j.crvasa.2017.05.015

Effectivity of left atrial appendage occlusion with AtriClip in 155 consecutive patients - Single center study

Vojtěch Kurfirst^*, Aleš Mokráček, Júlia Čanádyová, Alan Bulava, Ladislav Pešl

Kardiochirurgické oddělení, Kardiocentrum, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika

Objectives: Left atrial appendage (LAA) plays a crucial role in the etiopathogenesis of the stroke in patients with non-valvular atrial fibrillation. Different methods of surgical occlusion of the LAA have been associated with different levels of acute and chronic success rate. This paper presents our experience with LAA occlusion using the AtriClip.

Methods: 155 patients undergoing cardiac surgery procedures with epicardial AtriClip exclusion of the LAA were enrolled in the study. The AtriClip was placed via a sternotomy, thoracotomy or from a thoracoscopic approach. Postoperative variables such as thromboembolic events, clip stability, and endocardial leakage around the device were examined by transesophageal echocardiography (TEE) and/or computed tomography (CT). Patients were then contacted via telephone and questionnaire regarding episodes of stroke and actual anticoagulation therapy was completed.

Results: Avg. age of the study population was 66.9 years (102 males). Clip was implanted from sternotomy or thoracotomy in 77 patients and from thoracoscopy in 78 patients. The perioperative success rate of clip implantation was achieved in 98% of patients. 10 patients (6.4%) were revised for bleeding, but none of the revisions were due to clip implantation. During the hospitalization and follow-up period, consisting of 2422 patient-months, four of the cardiac patients experienced transitory ischemic attacks and two patients experienced a cerebrovascular attack.

Conclusions: Epicardial clip exclusion of the LAA appears to be a reproducible and safe surgical method with a high success rate. Our follow-up confirmed clip stability, complete occlusion of the LAA, and absence of any AF-related thromboembolic events. These results support regular usage of AtriClip during LAA closure.

Keywords: Atrial fibrillation; AtriClip; Left atrial appendage closure

Received: April 11, 2017; Revised: May 21, 2017; Accepted: May 22, 2017; Published: August 1, 2017  Show citation