Abstract
Background
Most thrombi originate from the left atrial appendage (LAA), and preventing thromboembolic stroke is an important aspect of stroke prevention. Previous studies have found that LAA closure is beneficial for preventing thrombosis. Currently, surgical procedures can achieve LAA closure by closing the endocardium or epicardium. Among them, only the LAA endocardial suture technique can be applied to both median thoracotomy and right minimally invasive cardiac surgery.
Aims
This study aims to evaluate the efficacy of LAAC with MICS.
Methods
A total of 74 patients who underwent LAAC during valve operation between 2017 to 2021 were included in this study. Of these, 42 patients underwent MICS. 32 patients who underwent valve surgery during full sternotomy were compared. LAAC uses a continuous suture from the insides. Patients underwent cardiac computed tomography (CT) and transthoracic echocardiography (TTE) follow-up approximately 18 months after surgery. Complete occlusion of the LAA after LAAO was defined as a radiodensity of < 100 HU, contrast opacification of < 25% of the left atrium, and LAAC without any leak.
Results
The LAA closure procedure was successful in 26 cases (81%) in the median thoracotomy group and 20 cases (48%) in the right minimally invasive group. Residual shunting (failed LAA closure) was more common in the right minimally invasive group (P: 0.003), and no correlation was found between residual shunting and left atrial (LA), left ventricular end-diastolic diameter (LVDD), and left ventricular ejection fraction (LVEF).
Conclusions
Compared with median thoracotomy, residual shunting after MICS was more common. CT imaging analysis of 22 patients with failed closure in the MICS group showed that residual shunting was mainly concentrated on margins of the suture (anterior superior and posterior inferior) (86%), with a middle area accounting for 3 (14%).