30^th European Pediatrics Conference

Introduction: There is a clear relationship between the left atrial appendage (LAA) and stroke in patients with nonvalvular AF. Recently, device closure of the LAA has emerged as a safe and effective alternative to anti-coagulation forsome patients. We present our experience of minimally invasive clipping of the LAA.

 

Results: We have performed thoracoscopic occlusion of the LAA using an epicardial clip (AtriClip) in 15 patients. LAA clipping was performed as a stand alone procedure, a hybrid procedure (in combination with catheter based ablation), part of a totally thoracoscopic AF ablation procedure or as an adjuvant in patients undergoing left thoracoscopic operations (e.g. lobectomy, lung biopsy). The clip is deployed epicardially over the base of the LAA under direct vision, effectively and reproducibly occluding the LAA.

 

In all cases the clip achieved complete LAA exclusion. It can be easily deployed via a minimally invasive surgical approach requiring only a short (30-45 minute) general anaesthetic. We have found minimally invasive LAA closure to be a safe, reliable and well-tolerated procedure.

 

Discussion: Unlike endocardial devices this method allows immediate cessation of anticoagulation medications, as the clip is placed epicardially there is no requirement for anticoagulation post deployment and no risk of complications related to device migration.

 

Thoracoscopic clipping of the LAA is an ideal option for:

• Patients who cannot tolerate/have contraindications to anticoagulation

• Patients in whom compliance to oral anticoagulation maybe an issue

Patients who experience thromboembolic events despite oral anti-coagulation.