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Background: The clinical implications of acute phase thrombosis after surgical left atrial appendage (LAA) closure remain unclear. This study sought to determine the frequency, prognosis, and factors involved in thrombogenesis after surgical LAA occlusion., Methods: In this study, data from patients who underwent 2 types of standalone surgical LAA closure (either resection or clipping) between July 2014 and March 2020 at a single center were analyzed., Results: A total of 239 consecutive patients with atrial fibrillation underwent minimally invasive standalone surgical LAA occlusion (184 resection cases and 55 clipping cases). On postoperative day 2, electrocardiogram synchronized contrast-enhanced computed tomography (CT) was performed in 223 cases (93.3%), and echocardiography follow-up was performed in 16 cases when CT was contraindicated. Acute postoperative thrombus on the closed stump was detected in 35 cases (14.7%), of which 29 cases (15.8%) belonged to the resection group and 6 cases (10.9%) belonged to the clipping group. No significant difference was detected between the groups, and no significant predictors of acute-phase thrombosis were found. Thromboembolism occurred in 4 patients before postoperative imaging follow-up, and there was no evidence of thrombi in these patients on postoperative day 2 CT. Three months after the first CT, thrombi were no longer detected in 34 of 35 patients (97.1%)., Conclusions: Thrombosis can occur after surgical LAA occlusion. Although the clinical significance is yet unclear, it may be reasonable to continue anticoagulation therapy until a lack of thrombosis is confirmed, unless there are contraindications., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: The present study evaluated the differences between left atrial appendage occlusion (LAAO) and left atrial appendage resection (LAAR) in terms of the safety and efficacy., Materials and Methods: From January 2018 to August 2022, 94 patients underwent a stand-alone LAAO, and 90 patients underwent stand-alone LAAR in our institution. All of these patients were included in this study. LAAO was performed via left mini-thoracotomy, and LAAR was performed via a left thoracoscopic approach. The patients' characteristics and perioperative and postoperative data were obtained by retrospectively reviewing their medical records., Results: The mean age of the patients was 72.4 ± 10.2 (LAAO) and 66.2 ± 9.4 (LAAR) years old (P < 0.05). There were no marked differences in the mean duration of atrial fibrillation (AF) or the ratio of AF type between both groups. The average CHA 2 DS 2 -Vasc scores were 4.4 ± 1.6 (LAAO) and 2.7 ± 1.8 (LAAR) (P < 0.05), and the average HAS-BLED scores were 2.9 ± 1.0 (LAAO) and 2.2 ± 1.2 (LAAR) (P < 0.05). The mean operation time was 49 ± 20 min (LAAO) and 34 ± 15 min (LAAR) (P < 0.05). No substantial gaps were detected in preoperative echo-graphic findings between the groups. No significant differences were observed in the amount of intraoperative or postoperative bleeding or the rate of intraoperative massive bleeding events between the groups. Successful LAA closure was achieved in all cases in both groups. Approximately 50% of patients underwent concomitant left pulmonary vein isolation (LPVI) during surgery, indicating no significant differences between the groups (P = 0.872). The early mortality rate was 1.04% in the LAAO group and 0% in the LAAR group (P = 0.132). There was no significant difference in the rate of postoperative LAA stump thrombus between the groups (8.5% in the LAAO group and 6.7% in the LAAR group; P = 0.320). The mean follow-up period was 851 ± 500 (6-1618) days in the LAAO group and 1208 ± 357 (49-1694) days in the LAAR group. Postoperative stroke events were detected in 1 patient in each group (P = 0.432). There was no significant difference in the sinus rhythm recovery rate after LPVI between these groups (31.1% in the LAAO group and 28.6% in the LAAR group; P = 0.763)., Conclusion: There were no significant differences between LAAO and LAAR in terms of the feasibility and the effectiveness as a method for stroke prophylaxis only to selected patients for both procedures, although further studies including the comparison between groups with the same backgrounds to confirm the authentic differences in the clinical results between these procedures., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Oral anticoagulants for atrial fibrillation are the standard approach to prevent stroke in patients with atrial fibrillation. However, oral anticoagulant therapy carries the risk of cerebral infarction recurrence, not to mention hemorrhagic complications, even under appropriate drug therapy. Surgical treatments targeting the left atrial appendage include left atrial appendage closure( LAAO) and left atrial appendage resection (LAAR). Our hospital uses AtriClip (approved and available in Japan since 2018) as a device for LAAO, and we investigated the early and long-term results of LAAO using AtriClip in our hospital. As a result, stable early to long-term results were expected for left atrial appendage closure using AtriClip device, suggesting that it may be an option that can be considered as a method for preventing stroke in patients with atrial fibrillation. But further investigation is required in the future.

Objective: The present study aimed to evaluate short- and middle-term results and postoperative anticoagulation of left atrial appendage (LAA) exclusion with an epicardial clip device., Materials and Methods: From September 2017 to August 2019, 102 patients at our institution underwent epicardial LAA exclusion using the AtriClip device. Anticoagulation therapy was resumed in the very early postoperative period and continued for at least three months after surgery. The patients' data were obtained by reviewing their medical records retrospectively., Results: The mean and median durations of follow-up was 510 ± 184 days and 482 days (range, 216-938 days), respectively. Successful LAA exclusion was confirmed in all but one patient. No device-related complications occurred during surgery. Postoperative computed tomography (CT) findings revealed no migration or displacement of the clips in any patient; however, small clots were observed at the LAA stump in seven patients. Stroke-free rate during the follow-up period was 98.9%., Conclusion: LAA exclusion using the AtriClip device was a feasible treatment method in terms of its early and middle-term safety and efficacy. In addition, our postoperative anticoagulation strategy could be optimal for maximizing the procedure's merits, although further studies, involving a larger number of patients and longer duration of follow-up, are needed.

Total endoscopic left atrial appendectomy for non-valvular atrial fibrillation(Af) has been reported to be a safe and effective procedure to prevent cardiogenic thromboembolism and also discontinue oral anticoagulant therapy. On the other hand, open-heart surgery is generally indicated for valvular Af. We report the case of a 67-year-old male patient with valvular Af and recurrent episodes of cardiogenic thromboembolism who underwent total endoscopic left atrial appendectomy. He was diagnosed as having mitral valve stenosis and scheduled for surgery, but presented with cerebellar hemorrhage after warfarin was replaced with heparin in the preoperative phase. Consequently, the operation was cancelled. The case was considered as a good relative indication for total endoscopic left atrial appendectomy, which does not need a cardiopulmonary bypass, to prevent future cardiogenic thromboembolism. The operation was performed and the postoperative course was uneventful.