Key result
AtriClip LAAO can cause delayed circumflex artery obstruction and myocardial infarction.
Why the study?
Acute coronary obstruction of the circumflex artery after left atrial appendage occlusion by an extracardiac clip has been described, but delayed obstruction after open-heart surgery is less reported.
Case Report (n=1)
Extracardiac left atrial appendage occlusion clips can cause delayed circumflex artery obstruction, highlighting the need for careful placement away from the LAA base.
Alerts to possible delayed circumflex obstruction after AtriClip LAAO; leaves open incidence, surveillance needs, and preventive strategies.
Closure of the left atrial appendage is a common procedure for patients with atrial fibrillation undergoing cardiac surgery. The technique of left atrial appendage occlusion (LAAO) by an extracardiac clip (AtriClip) is established as a reliable method. Acute coronary obstruction of the circumflex artery has already been described after minimally invasive LAAO. Here, we report a case of delayed circumflex artery obstruction after open-heart surgery. A patient who had mitral and tricuspid valve surgery in combination with AtriClip implantation suffered from myocardial infarction 24 h after clip implantation. Cardiac catheterization showed that the circumflex artery was obstructed on the level of the AtriClip device. The stenosis was treated by percutaneous coronary intervention with stent implantation. In conclusion, the surgeon should consider placing the AtriClip device slightly far away from the base of the left atrial appendage to avoid coronary obstruction.
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Kuzmin et al. (2020) conducted a case report in Atrial fibrillation (n=1). Left atrial appendage occlusion (AtriClip) was evaluated. Left atrial appendage occlusion using an AtriClip caused delayed circumflex artery obstruction and myocardial infarction 24 hours after implantation, requiring percutaneous coronary intervention.
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