Why should cardiac surgeons occlude the left atrial appendage percutaneously?

Abstract

Objectives: Percutaneous left atrial appendage (LAA) occlusion (LAAO) is a procedure dominated by cardiologists. The aim of our study was to present the results of percutaneous LAAO performed solely by cardiac surgeons. Methods: Two hundred twenty-three consecutive patients with nonvalvular atrial fibrillation underwent percutaneous LAAO in two cardiac surgery sites. In the first center, all 84 LAAO procedures were performed with the endocardial LAA occluders: 60 cases with the Amulet and 24 cases with the LAmbre. In the second center, all 139 LAAO procedures were performed with the LARIAT epicardial device. Results: The mean CHA 2 DS 2-VASc-score was 3.7 ± 1.8 points, and mean HAS-BLED score was 3.6 ± 1.2 points. The procedure was successful in 97.3% of cases. Procedural or device-related adverse events were noted in 4.4% (n = 10) of cases: one periprocedural cardiac arrest, one aortic injury, one gastrointestinal bleeding, three cases of vascular access complications, and four cardiac tamponades. After a followup of 40.3 ± 17.3 months, 78.4% of patients were alive, with the annual mortality rate of 5.3%. Compared to the predicted risk, the observed incidence of thromboembolism was lower by 71%, and the bleeding incidence was lower by 69%. Conclusions: Percutaneous LAAO procedures can be safely performed by cardiac surgeons, with no cardiological assistance. LAAO done by surgeons is safe and effective, and periprocedural and long-term outcomes are excellent. Cardiac surgeons should be trained in both types of LAAO: endocardial and epicardial.

Transcatheter procedures in structural heart disease: The surgeon stepping‐in

“…All interventions were performed by surgeons, who had undergone pretraining in a simulation model. Soon, thereafter, they were able to achieve outcomes that were comparable with those obtained by experienced interventional cardiologists 1 …”

“…In this issue of the Journal, Litwinowicz et al 1 describe their trailblazing experience in 223 consecutive patients in whom they performed left atrial appendage occlusion (LAAO) via the percutaneous route. All interventions were performed by surgeons, who had undergone pretraining in a simulation model.…”

“…The self‐reliant approach taken by Litwinowicz et al 1 should be commended and replicated and sets the pace for surgeons around the world. Despite ingrained skepticism and rejection, we strongly advise surgeons to be prepared for this ongoing and rapidly changing landscape and to seize the timely opportunity.…”

The safety and efficacy of the LAmbre left atrial appendage closure device in atrial fibrillation: a systematic review and meta-analysis

“…Three hundred and nine articles were obtained by online and manual searches. After removing duplicates, screening titles and abstracts, four independent trials [25][26][27][28] contained data for the LAmbre occluder versus other LAAC devices were selected that included 607 patients (142 randomized to the LAmbre occluder and 465 to other LAAC devices). (Figure 1) (as seen in the flow chart).…”

“…23,24 Some studies compared the clinical outcomes of the LAmbre occluder to those of other LAAC devices, which with contradictory results. The LAmbre occluder had a higher rate of device-related thrombus(DRT) than other LAAC devices, according to Schnupp et al 25 and Chen et al 26 , whereas Litwinowicz et al 27 found the opposite. The goal of this study was to compare the safety and efficacy of the LAmbre occluder to that of other LAAC devices.…”