Role of video-assisted thoracoscopy in the management of stroke

Abstract

To evaluate the role of surgery (anterior thoracotomy versus video-assisted thoracoscopy) in avoidance of stroke by obliteration of the left atrial appendage in patients with chronic nonrheumatic atrial fibrillation. In a prospective study, 58 patients (35 men and 23 women, aged 62 ± 13.2 years) with chronic nonrheumatic atrial fibrillation were divided into 2 groups: group A was 29 patients who underwent an anterior thoracotomy, and group B was 29 patients who had video-assisted thoracoscopic obliteration of the left atrial appendage. All patients were followed up for at least 2 years. The 2 groups were well matched for age, sex, and comorbidities. No stroke was observed in either group. Operative time was significantly longer in group B. There was no intraoperative or postoperative complication, except for 2 cases of superficial wound infection in group A. In chronic atrial fibrillation, prophylactic left atrial appendage exclusion is suggested to prevent occurrence of stroke, which can be achieved by a surgical or thoracoscopic approach, but a video-assisted thoracoscopic approach is effective, less invasive, and avoids the complications of a surgical approach.