First Australian Experience with Total Thoracoscopic Left Atrial Appendage Occlusion with Atriclip PRO2 device

Abstract

Introduction: Oral anticoagulation (OAC) decreases ischaemic stroke in non-valvular atrial fibrillation (AF). Closure of the left atrial appendage (LAA) should be considered in patients unsuitable for OAC. We describe the first Australian series of totally thoracoscopic external LAA occlusion with the Atriclip PRO2TM device. Methods: Patients with chronic AF at high risk of stroke and unable to take anticoagulation, or with embolic events despite anticoagulation, were considered for Atriclip device by a Heart Team at the Mount Hospital, Western Australia. All procedures were performed thoracoscopically, and not associated with any other cardiothoracic procedure. Under transesophageal echocardiography (TOE) guidance, LAA thrombus was excluded, and three 5-mm left chest ports were used for thoracoscopic insertion of the AtriClip device. Results: All 15 patients (mean age 77 years, 11 males) deemed suitable for the device underwent the procedure successfully with mean procedure time of 26 minutes. Median CHA2DS2VaSC and HASBLED scores were 4.5 (range 2–7) and 4 (1–5), respectively. No complication, reoperation, infection or persistent wound pain was reported. The median postoperative stay was 2 days (range 1–14 days) with no ICU admissions, and good to excellent patient satisfaction scores. A total of 2203 patient-days of post-discharge follow-up were obtained with no strokes despite no patient taking anticoagulants or antiplatelet agents. Post-procedure TOE and follow-up CT scans confirmed successful LAA occlusion (figure). Conclusions: Our initial experience with thoracoscopic LAA occlusion using the Atriclip device is excellent, with good safety, short procedure times and hospital stays, high satisfaction scores and no strokes during follow-up. Figure: 3D TOE showing complete LAA occlusion (left panel) and 3D CT reconstruction showing Atriclip device (right panel)