World J Surg Surg Res | Volume 6, Issue 1 | Research Article | Open Access
Hamzah AW, Gu JX, Liu H, Cai YP, Du JJ and Shao YF*
Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, China
*Correspondance to: Yong-Feng ShaoFulltext PDF
Objectives: To determine the efficacy of thoracoscopic stand-alone left atrial appendectomy for stroke prevention in nonvalvular atrial fibrillation.
Background: It is suggested that left atrial appendectomy provided a potential alternative to oral anticoagulation as against AF-induced stroke prevention. Methods: Consecutive participants were enrolled at the First Affiliated Hospital of Nanjing Medical University between January 2015 and December 2021 who had nonvalvular AF as well as a history of stroke or a systemic thromboembolic event using an endoscopic cutter, the left atrial appendage were thoracoscopically resected. Results: Thirty-six patients (23 male, median age, 67 years) were finally included with a median AF duration of 60.0 (IQR 24.0-120.0) months. Patients had a median CHADS2 score of 3.0 (IQR 2.0-3.0), CHA2DS2-VASC score of 4.0 (3.0-4.0), and HAS-BLED score of 3.0 (2.0-4.0), respectively. A previous stroke or transient ischemic attack had occurred in 26 (72.2%) of the patients, and hemiplegia had occurred in 12 (33.3%) of the patients. Twenty patients had a history of bleeding and were not eligible for anticoagulation treatment, while 15 had received warfarin as an anticoagulant. There was a median follow-up time of 40.2 (IQR 33.0-50.2) months. Eighteen individuals had brain computed tomography and/or MRI at follow-up. Eight individuals only underwent anti-platelet medications; the remaining patients all avoided re-anticoagulation. At 6 months and 18 months of follow-up, there were 2 deaths as a result of cerebral hemorrhage incidents.
Conclusion: Thoracoscopic stand-alone appendectomy is an effective and safe technique for nonvalvular atrial fibrillation patients, which offered satisfactory mid-term prophylaxis without using anticoagulation therapy.
Left Atrial Appendectomy; Atrial Fibrillation; Thoracoscopy; Thromboembolic stroke
Hamzah AW, Gu JX, Liu H, Cai YP, Du JJ , Shao YF. Stand-Alone Left Atrial Appendage Excision via a Thoracoscopic Approach for Secondary Stroke Prevention in NV Afib Patients. World J Surg Surgical Res. 2023; 6: 1445..