Key result
Minimally invasive LAAC is linked to ~41% lower closure success than median sternotomy.
Why the study?
LAA endocardial suture can be performed during sternotomy or right MICS, but the efficacy of LAAC with MICS required evaluation.
Does endocardial suture occlusion of the left atrial appendage during minimally invasive cardiac surgery (MICS) reduce residual shunting compared to sternotomy in adult valvular patients with atrial fibrillation?
Cohort (n=74)
No
Does endocardial suture occlusion of the left atrial appendage during minimally invasive cardiac surgery (MICS) reduce residual shunting compared to sternotomy in adult valvular patients with atrial fibrillation?
Endocardial suture occlusion of the left atrial appendage during minimally invasive cardiac surgery results in a significantly higher rate of residual shunting compared to sternotomy, suggesting a need for technique modification such as reinforcing suture margins.
Answers are grounded in this paper and cite their sources.
Minimally invasive LAA closure success was lower than sternotomy; retrospective data leave open whether technique refinements improve outcomes.
BACKGROUND: Most thrombi originate from the left atrial appendage (LAA), 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. LAA endocardial suture technique is performed concomitantly during sternotomy cardiac surgery but can also be performed during right minimally invasive cardiac surgery (MICS). AIMS: This study aims to evaluate the efficacy of left atrial appendage closure (LAAC) with MICS. METHODS: A total number of 74 patients who underwent LAAC during valve operation between 2017 and 2021 were retrospectively analyzed in this study. LAA was closed by continuous suture through the endocardium of the left atrium during cardiac surgery. 42 patients performed LAA endocardial suture during MICS, while 32 patients performed with the same LAAC technique during sternotomy. Patients underwent cardiac computed tomography (CT) follow-up after surgery to verify the completeness of the LAAC. The heart structure and function were recorded by echocardiography Transthoracic echocardiography (TTE), and the heart rhythm was recorded by electrocardiogram. RESULTS: The LAA closure procedure was successful in 26 cases (81%) in the sternotomy 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). The incidence of leaks was not associated with mitral valve replacement or valvuloplasty. CONCLUSIONS: Compared to sternotomy, 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%). Based on this finding, reinforcing the suture margins may significantly reduce the incidence of incomplete closure. THE CLINICAL TRIAL NUMBER: KY-2023-001.
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Huang et al. (2025) conducted a cohort in Valvular heart disease with persistent atrial fibrillation (n=74). Minimally invasive cardiac surgery (MICS) for left atrial appendage closure vs. Median sternotomy for left atrial appendage closure was evaluated on Successful left atrial appendage closure (p=0.003). Minimally invasive cardiac surgery for left atrial appendage closure resulted in a lower success rate compared to median sternotomy.
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