Key result
Stand-alone thoracoscopic LAA closure achieves 100% complete occlusion without operative complications or early mortality.
Why the study?
In nonvalvular AF patients at high bleeding risk, OAC may be contraindicated, but percutaneous LAA closure requires post-procedure OAC or dual antiplatelet therapy.
Does stand-alone thoracoscopic LAA closure without subsequent antithrombotic therapy safely prevent cerebrovascular events in nonvalvular AF patients at high bleeding risk?
Observational (n=20)
Does stand-alone thoracoscopic LAA closure without subsequent antithrombotic therapy safely prevent cerebrovascular events in nonvalvular AF patients at high bleeding risk?
Stand-alone thoracoscopic LAA closure with an epicardial clip appears to be a safe and feasible alternative for stroke prevention in AF patients with absolute contraindications to antithrombotic therapy.
May support feasibility of stand-alone thoracoscopic LAA closure in high-bleeding-risk AF; hypothesis-generating and requires RCTs before any practice change.
Objective In nonvalvular atrial fibrillation (AF) patients at high bleeding risk, oral anticoagulants (OAC) may be contraindicated, and percutaneous left atrial appendage (LAA) closure has been advocated. However, following percutaneous procedure, either OAC or dual antiplatelet treatment is required. In this study, we present our experience in treating nonvalvular AF patients at high bleeding risk with thoracoscopic LAA closure with no subsequent antithrombotic therapy. Methods From April 2019 to January 2020, 20 consecutive AF patients, mean age 75.1 years, 16 (80%) males, underwent thoracoscopic LAA closure as a stand-alone procedure, using an epicardial clip device. OAC and antiplatelet therapy were contraindicated. Mean CHA 2 DS 2 -VASc score was 3.61, and the mean HAS-BLED score was 4.42. Successful LAA closure was assessed by transesophageal echocardiography. Primary endpoints were complete LAA closure (no residual LAA flow), operative complications, and all-cause mortality; secondary endpoints were 30-day and 6-month complications (death, ischemic stroke, hemorrhagic stroke, transient ischemic attack, any bleeding). Mean follow-up was 6 ± 4 months. Results Complete LAA closure was achieved in all patients. No operative clip-related complications or deaths occurred. At follow-up, freedom from postoperative complications was 95% and from any cerebrovascular events was 100%. Overall survival rate was 100%. Conclusions In nonvalvular AF patients at high bleeding risk (HAS-BLED score >3), thoracoscopic LAA closure appears to be a valid alternative to percutaneous techniques not requiring dual antiplatelet or OAC treatment. Apparently, external LAA clipping minimizes the risk of thromboembolic events as compared with percutaneous procedures.
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Franciulli et al. (2020) conducted an observational in Nonvalvular atrial fibrillation at high bleeding risk (n=20). Thoracoscopic left atrial appendage closure was evaluated on Complete LAA closure (no residual LAA flow), operative complications, and all-cause mortality. Thoracoscopic left atrial appendage closure as a stand-alone procedure achieved 100% complete closure with 0% operative complications and 100% overall survival at a mean follow-up of 6 months.
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