Comparative characteristics of endovascular occlusion and thoracoscopic amputation of left atrial appendage in patients with atrial fibrillation

Abstract

Aim. To compare the effectiveness and safety of endovascular occlusion and thoracoscopic amputation of the left atrial appendage (LAA) in patients with atrial fibrillation (AF).Methods. We present a retrospective single-center study with a prospective component including 25 patients with AF who underwent thoracoscopic amputation of the LAA and 31 patients on prospective part who underwent endovascular occlusion of the LAA. All patients signed voluntary informed consent for medical intervention and participation in the study. The criteria for selecting patients for thoracoscopic amputation of the LAA were the impossibility of performing an endovascular technique, features of its anatomy and increased trabecularity.Results. In the group of patients with thoracoscopic amputation of the LAA, 2 cases of embologenic stump of the LAA with a depth of 1.6 cm (8%) were identified; these patients were recommended to continue taking anticoagulant therapy. Among patients who underwent thoracoscopic amputation, no complications were identified in the first 30 days after surgery, including mortality, bleeding, phrenic nerve paresis, acute cerebrovascular accident, pleurisy, pneumothorax, hemothorax. In 3 patients who underwent endovascular occlusion of the LAA, hematomas were detected at the site of puncture of the great vessels (9.7%), in 2 patients thrombus were detected on the occlusion device according to the results of transesophageal echocardiography (6.5%), which required the prescription of warfarin in these patients. Also, in 2 patients (6.5%) during implantation of the occluder into the LAA, as a result of the incorrect diameter of the disk of the occluding device, a residual cavity with a depth of 0.7 cm was formed between the ridge and the occluder. No significant differences in the frequency of non-severe complications were found in the groups, p =0.139. During the year of postoperative observation, thromboembolic complications were absent in the operated patients of both groups.Conclusion. When comparing two methods of LAA isolation, no severe complications were identified, either in the perioperative or in the early or late postoperative period. There were no significant differences in the incidence of non-severe complications in the early postoperative period. Thus, the effectiveness and safety of thoracoscopic amputation and endovascular occlusion of the left atrial appendage are comparable.