Initial Experience with Robotic Surgical Exclusion of the Left Atrial Appendage
Nathan Smith, M.D.1, Erin Harris2, Benjamin Gallant3, Olatoye Olutola, M.D.1, Sanjay Samy, M.D.1, Walter Scott, M.D.1.
1Albany Medical Center, Albany Medical Center, NY, USA, 2Albany Medical Center, Albany Medical College, NY, USA, 3Albany Medical College, Albany Medical College, NY, USA.
OBJECTIVE: Amongst individuals with non-valvular AF that experience embolic strokes, 90% arise from the left atrial appendage (LAA), and consequently LAA closure can be considered for patients unable to tolerate anticoagulation medications. Surgical exclusion of the LAA decreases the yearly risk of stroke to 0.7% when used in combination with a Maze procedure. Epicardial exclusion can be used to eliminate the thrombogenic, low-flow cavity of the left atrial appendage, theoretically reducing the stroke risk by 90%. Epicardial clipping can be done through a sternotomy or via a minimally invasive approach using a video-assisted surgical or a robotic approach. We present here our initial institutional experience of epicardial clipping of the LAA using a robotic assisted thoracoscopic approach.
METHODS/RESULTS: The mean age was 75.9-years. The mean CHA2DS2VASC score was 4.3, and the mean HAS-BLED. score was 3.1. The mean postoperative length of stay was 2.2 days. Two cases were aborted due to an inability to achieve domain, and dense pleural adhesions, respectively. One patient developed acute pericarditis postoperatively that was easily treated with colchicine and pain medication. Another patient developed respiratory failure because of over-sedation. Finally, one of the patients developed hemorrhagic shock, resulting in return to the operating room for median sternotomy.
CONCLUSIONS: Epicardial LAA clipping using a robotic approach shows promising results for high risk patients with AF, with fewer complications. Long term success in preventing stroke is still yet to be determined, but short-term results are encouraging and equivocal to the minimally invasive approach.
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