Left Atrial Appendage Resection Can Reduce Thrombotic Risk of Chronic Atrial Fibrillation

Abstract

Introduction: We tested a hypothesis that endoscopic left atrial appendage (LAA) resection can reduce the thrombotic risk in patients with chronic atrial fibrillation (AF). Methods: Seven patients (six men, one women, 71±9.5 years old) underwent totally endoscopic LAA resection for long standing AF. With the left atrium oversized (>6 cm) to be indicated for the curative ablative treatment, all the cases had suffered from repeated thrombotic events, e.g., stroke and superior mesenteric arterial thrombosis, for which coumadin had been long administered, and the dangerously prolonged INR (>3.0) had significantly disturbed their lives and restrained their activities. Results: Through three endoscopic ports on the left lateral thorax, the LAA was totally removed with an endo-stapler. Operative time was 35±6.5 min. Trans-esophageal echo-cardiography revealed the preoperative smoke sign from the LAA completely disappeared after surgery. There was no deaths nor major complications. As patients strongly demanded so, five cases were cut off from coumadin and two were given the greatly reduced dosages. Nevertheless, all cases with the 8.5±3.8 follow-up months are free from thrombotic accidents and one-year post-operative enhanced computed tomography in four patients showed the completely removed LAA and no signs of thrombi in the left atrium. Conclusion: Endoscopic total resection of the LAA has a preventive effect from thrombotic events in chronic AF patients, making a dangerous dose of coumadin dispensable.