Korean J Thorac Cardiovasc Surg.  2020 Jun;53(3):127-131. 10.5090/kjtcs.2020.53.3.127.

Safety and Efficacy of Left Atrial Appendage Excision Using a Vascular Stapler

Affiliations
  • 1Departments of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 2Departments of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Abstract

Background
This study was conducted to evaluate the safety and efficacy of left atrial appendage (LAA) excision using a vascular stapler.
Methods
Fifty consecutive patients (mean age, 68±9 years) who underwent LAA excision using a vascular stapler during concomitant cardiac surgery were enrolled. In all patients, the excision site was evaluated using computed tomography at a median of 7 days (interquartile range, 5–13.3 days) postoperatively. The safety endpoint of this study was the occurrence of LAA excision-related events, which were defined as bleeding from the excision site that required reinforcement sutures or reoperation due to excision site bleeding. The efficacy endpoint was LAA excision failure, which was defined as a remnant LAA (a stump >1 cm in maximum length) or extravasation of radiocontrast dye.
Results
LAAs were excised using 60- and 45-mm vascular staplers in 49 patients and 1 patient, respectively. Reinforcement sutures were needed in 4 patients due to staple-line bleeding and in 4 patients due to bleeding of the surrounding tissues. No patient underwent reoperation due to staple-related bleeding. A remnant LAA was observed in 2 patients, while extravasation of radiocontrast dye was not observed in any patients.
Conclusion
LAA excision using a vascular stapler may be an effective technique for LAA exclusion. Delicate handling of the stapler device and LA tissue is required to prevent procedure- related complications.

Keyword

Arrhythmia; Atrial fibrillation; Thrombosis; Computed tomography angiography
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