Abstract 11056: Thoracoscopic Left Atrial Appendage Occlusion with Atriclip TM : An Initial Experience

Abstract

Introduction: Left atrial appendage (LAA) closure is an important tool in stroke prevention. Totally thoracoscopic LAA closure using the AtriClip™ device avoids intracardiac components, although early outcomes have not been systematically documented. Methods and Results: 105 consecutive fully thoracoscopic AtriClip TM procedures were examined, involving 84(80%) males, 21(20%) females and mean (+/- SD) age 70.1+/-9.2 years. The most common indication was as part of an AF ablation procedure (n=38, 36.2%), or anticoagulation-related hemorrhage (n=27, 25.7%). Median (interquartile range, IQR) CHADS 2 VaSc = 3 (2-4) and HAS-BLED = 3 (1-3). Half the patients (n=51, 48.6%) underwent isolated AtriClip insertion, 90% had a size 40 or 45mm AtriClip device, and none experienced circumflex coronary artery or phrenic nerve compromise. Intraprocedural transesophageal echocardiography demonstrated complete occlusion in all patients. Follow-up at 6 weeks with CT or transesophageal echocardiography confirmed occlusion in all patients (79% follow-up). The length of stay for isolated thoracoscopic AtriClip TM was 3 days (IQR 2-4) with longer admissions due to unrelated conditions (e.g. heart failure, AF or chest infection). No cases of LAA perforation were recorded and no patients with isolated AtriClip required transfusion. Transient pericarditis occurred in 10 patients (9.5%, 5 requiring readmission within 30 days) with a pericardial effusion in 3 patients (2.9%, requiring pericardiocentesis in one patient). No strokes occurred and 93% of isolated Atriclip patients had ceased anticoagulation at 30 days. Conclusions: Total thoracoscopic LAA closure using the AtriClip device is safe and effective. The most common complication is transient pericarditis (9.5%) and major complications were not seen.