Why should cardiac surgeons occlude the left atrial appendage percutaneously?. Issue 12 (16th September 2020)

• Record Type: Journal Article
• Authors: Litwinowicz, Radoslaw; Mazur, Piotr; Burysz, Marian; Filip, Grzegorz; Wasilewski, Grzegorz; Kapelak, Boguslaw; Bartus, Krzysztof
• Is Part Of: Journal of cardiac surgery. Volume 35:Issue 12(2020)
• Page Start: 3458
• Page End: 3464
• Publication Date: 2020-09-16
• Subjects: atrial fibrillation -- cardiac surgeon -- LAAO -- left atrial appendage -- percutaneous procedure; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.14991
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Objectives: Percutaneous left atrial appendage (LAA) occlusion (LAAO) is a procedure dominated by cardiologists. The aim of our study was to present the results of percutaneous LAAO performed solely by cardiac surgeons. Methods: Two hundred twenty‐three consecutive patients with nonvalvular atrial fibrillation underwent percutaneous LAAO in two cardiac surgery sites. In the first center, all 84 LAAO procedures were performed with the endocardial LAA occluders: 60 cases with the Amulet and 24 cases with the LAmbre. In the second center, all 139 LAAO procedures were performed with the LARIAT epicardial device. Results: The mean CHA2 DS2 ‐VASc‐score was 3.7 ± 1.8 points, and mean HAS‐BLED score was 3.6 ± 1.2 points. The procedure was successful in 97.3% of cases. Procedural or device‐related adverse events were noted in 4.4% (n = 10) of cases: one periprocedural cardiac arrest, one aortic injury, one gastrointestinal bleeding, three cases of vascular access complications, and four cardiac tamponades. After a follow‐up of 40.3 ± 17.3 months, 78.4% of patients were alive, with the annual mortality rate of 5.3%. Compared to the predicted risk, the observed incidence of thromboembolism was lower by 71%, and the bleeding incidence was lower by 69%. Conclusions: Percutaneous LAAO procedures can be safely performed by cardiac surgeons, with no cardiological assistance. LAAO done by surgeons is safe and effective, and periprocedural and long‐term outcomes are excellent. Cardiac surgeons should be trained in both types of LAAO: endocardial and epicardial.