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ISMICS 2023 Annual Meeting
31 May - 3 June, 2023 | Boston, MA
PC12
Thoracoscopic Left Atrial Appendage Exclusion For Atrial Fibrillation Patients Intolerant To Anti-coagulation
Poster Presenter
Authors
Omar Sharaf, Matheus Falasa, Todd Jones, Anna Khanna, Kun Xiang, Philip George, Vilma Torres, William Miles, Thomas Beaver
Affiliations
Part of Topic
Arrhythmia Surgery & Interventions
Thoracoscopic Left Atrial Appendage Exclusion for Atrial Fibrillation Patients Intolerant to Anti-Coagulation
Purpose
•The Left Atrial Appendage Occlusion Study (LAAOS) III trial showed benefit of left atrial appendage exclusion with concomitant cardiac surgery.
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•However, most patients in LAAOS III remained on anticoagulation.
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•Outcomes with isolated thoracoscopic epicardial left atrial appendage (LAA) exclusion in atrial fibrillation (AF) patients with a contraindication to anticoagulation are not clearly defined, especially in patients with prior stroke.
Methods
•Single-center retrospective study of adults (≥18 years) undergoing isolated thoracoscopic LAA exclusion with an epicardial exclusion device without a concomitant surgical procedure between 1/1/2010 and 6/30/2022.
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•Intraoperative postprocedural transesophageal echocardiography was performed to confirm flush occlusion of the LAA, with technical success defined as LAA stump length of <10 mm.
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•Continuous data are presented as mean±standard deviation or median (interquartile range). Categorical variables are presented as % (N).
Results
•N=25 Patients
•Baseline Characteristics
•Mean age 76.4 ± 6.5 years / 68% male
•Preop CHA2DS2-VASc score 4.2 ± 1.4
•Preop HAS-BLED score 2.68 ± 1.03
•68% (n=17) had non-paroxysmal AF
•Indications
•N= 22 (88%) Intolerance to anticoagulation: Intracranial Bleed (50%, n=11), GI Bleed (27%, n=6), GU Bleed (18%, n=4), and Skin reaction (4.5%, n=1)
•N=2 (8.0%) patient preference desired to stop anticoagulation
•N=1 (4.0%) had a contraindication to anticoagulation due to a study drug
•Procedural Details
•100% technical success (LAA stump length <10 mm)
•Mean operative duration of 58.7±42.2 minutes
•Follow-Up
•Mean follow-up time of 566.9 ± 506.1 days
•100% off anticoagulation
•0 postoperative strokes
Conclusions
Examination of adult patients with AF, high stroke risk, and intolerance/contraindication to anticoagulation who underwent isolated thoracoscopic LAA exclusion reveals:
1.Isolated epicardial LAA exclusion may be an appropriate alternative to anticoagulation and may be preferable to endocardial LAA occlusion.
2.In this high-risk patient population, careful patient selection is necessary to avoid morbidity.