Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy
BackgroundLeft atrial appendage (LAA) is a common source of thrombi in patients with atrial fibrillation (AF). The effect on left atrial (LA) function of the Totally Thoracoscopic (TT)-LAA exclusion with epicardial clip is currently unknown. This study aims at evaluating the effect of TT-LAA exclusi...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-11-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1036574/full |
| _version_ | 1811330738799247360 |
|---|---|
| author | Massimiliano Marini Massimiliano Marini Luigi Pannone Stefano Branzoli Stefano Branzoli Francesca Tedoldi Giovanni D’Onghia Diego Fanti Emanuele Sarao Fabrizio Guarracini Silvia Quintarelli Cinzia Monaco Angelo Graffigna Roberto Bonmassari Mark La Meir Gian Battista Chierchia Carlo de Asmundis |
| author_facet | Massimiliano Marini Massimiliano Marini Luigi Pannone Stefano Branzoli Stefano Branzoli Francesca Tedoldi Giovanni D’Onghia Diego Fanti Emanuele Sarao Fabrizio Guarracini Silvia Quintarelli Cinzia Monaco Angelo Graffigna Roberto Bonmassari Mark La Meir Gian Battista Chierchia Carlo de Asmundis |
| author_sort | Massimiliano Marini |
| collection | DOAJ |
| description | BackgroundLeft atrial appendage (LAA) is a common source of thrombi in patients with atrial fibrillation (AF). The effect on left atrial (LA) function of the Totally Thoracoscopic (TT)-LAA exclusion with epicardial clip is currently unknown. This study aims at evaluating the effect of TT-LAA exclusion on LA function.MethodsStandalone TT-LAA exclusion with the clip device was performed in 26 patients with AF and contraindication to oral anticoagulation (OAC). A 3D CT scan, trans-esophageal echocardiography, spirometry and cerebrovascular doppler ultrasound were performed preoperatively. Clip positioning and LAA exclusion were guided and confirmed by intraoperative trans-esophageal echo. To evaluate LA function, standard transthoracic echocardiography and 2D strain of LA were performed before surgery, at discharge and at 3-month follow-up.ResultsThe mean CHA2DS2-VASc and HASBLED scores were 4.6 and 2.4 respectively. There were no major complications during the procedure. At median follow-up of 10.3 months, 1 (3.8%) non-cardiovascular death, 1 (3.8%) stroke and 4 (15.4%) cardiovascular hospitalizations occurred. At 2D strain of LA, the reservoir function decreased significantly at discharge, compared to baseline and recovered at 3-months follow-up. Furthermore, NT-proBNP increased significantly after the procedure with a return to baseline after 3 months. Changes in E/A were persistent at 3 months.ConclusionOur data in a small cohort suggest that TT-LAA exclusion with epicardial clip can be a safe procedure with regards to the atrial function. The LAA amputation impairs the reservoir LA function on the short term, that recovers over time. |
| first_indexed | 2024-04-13T16:08:23Z |
| format | Article |
| id | doaj.art-b768ecd1745449c9a7b3a09a0b87bc60 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T16:08:23Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-b768ecd1745449c9a7b3a09a0b87bc602022-12-22T02:40:21ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-11-01910.3389/fcvm.2022.10365741036574Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapyMassimiliano Marini0Massimiliano Marini1Luigi Pannone2Stefano Branzoli3Stefano Branzoli4Francesca Tedoldi5Giovanni D’Onghia6Diego Fanti7Emanuele Sarao8Fabrizio Guarracini9Silvia Quintarelli10Cinzia Monaco11Angelo Graffigna12Roberto Bonmassari13Mark La Meir14Gian Battista Chierchia15Carlo de Asmundis16Department of Cardiology, S. Chiara Hospital, Trento, ItalyHeart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, BelgiumHeart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, BelgiumDepartment of Cardiac Surgery, S. Chiara Hospital, Trento, ItalyDepartment of Cardiac Surgery, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, BelgiumDepartment of Cardiology, S. Chiara Hospital, Trento, ItalyDepartment of Cardiology, S. Chiara Hospital, Trento, ItalyDepartment of Cardiology, S. Chiara Hospital, Trento, ItalyDepartment of Cardiology, S. Chiara Hospital, Trento, ItalyDepartment of Cardiology, S. Chiara Hospital, Trento, ItalyDepartment of Cardiology, S. Chiara Hospital, Trento, ItalyHeart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, BelgiumDepartment of Cardiac Surgery, S. Chiara Hospital, Trento, ItalyDepartment of Cardiology, S. Chiara Hospital, Trento, ItalyDepartment of Cardiac Surgery, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, BelgiumHeart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, BelgiumHeart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, BelgiumBackgroundLeft atrial appendage (LAA) is a common source of thrombi in patients with atrial fibrillation (AF). The effect on left atrial (LA) function of the Totally Thoracoscopic (TT)-LAA exclusion with epicardial clip is currently unknown. This study aims at evaluating the effect of TT-LAA exclusion on LA function.MethodsStandalone TT-LAA exclusion with the clip device was performed in 26 patients with AF and contraindication to oral anticoagulation (OAC). A 3D CT scan, trans-esophageal echocardiography, spirometry and cerebrovascular doppler ultrasound were performed preoperatively. Clip positioning and LAA exclusion were guided and confirmed by intraoperative trans-esophageal echo. To evaluate LA function, standard transthoracic echocardiography and 2D strain of LA were performed before surgery, at discharge and at 3-month follow-up.ResultsThe mean CHA2DS2-VASc and HASBLED scores were 4.6 and 2.4 respectively. There were no major complications during the procedure. At median follow-up of 10.3 months, 1 (3.8%) non-cardiovascular death, 1 (3.8%) stroke and 4 (15.4%) cardiovascular hospitalizations occurred. At 2D strain of LA, the reservoir function decreased significantly at discharge, compared to baseline and recovered at 3-months follow-up. Furthermore, NT-proBNP increased significantly after the procedure with a return to baseline after 3 months. Changes in E/A were persistent at 3 months.ConclusionOur data in a small cohort suggest that TT-LAA exclusion with epicardial clip can be a safe procedure with regards to the atrial function. The LAA amputation impairs the reservoir LA function on the short term, that recovers over time.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1036574/fullleft atrial appendage exclusionoral anticoagulation therapytotally thoracoscopic surgeryatrial fibrillationleft atrial appendage |
| spellingShingle | Massimiliano Marini Massimiliano Marini Luigi Pannone Stefano Branzoli Stefano Branzoli Francesca Tedoldi Giovanni D’Onghia Diego Fanti Emanuele Sarao Fabrizio Guarracini Silvia Quintarelli Cinzia Monaco Angelo Graffigna Roberto Bonmassari Mark La Meir Gian Battista Chierchia Carlo de Asmundis Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy Frontiers in Cardiovascular Medicine left atrial appendage exclusion oral anticoagulation therapy totally thoracoscopic surgery atrial fibrillation left atrial appendage |
| title | Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy |
| title_full | Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy |
| title_fullStr | Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy |
| title_full_unstemmed | Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy |
| title_short | Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy |
| title_sort | left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy |
| topic | left atrial appendage exclusion oral anticoagulation therapy totally thoracoscopic surgery atrial fibrillation left atrial appendage |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1036574/full |
| work_keys_str_mv | AT massimilianomarini leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT massimilianomarini leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT luigipannone leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT stefanobranzoli leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT stefanobranzoli leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT francescatedoldi leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT giovannidonghia leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT diegofanti leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT emanuelesarao leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT fabrizioguarracini leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT silviaquintarelli leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT cinziamonaco leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT angelograffigna leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT robertobonmassari leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT marklameir leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT gianbattistachierchia leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy AT carlodeasmundis leftatrialfunctionafterstandalonetotallythoracoscopicleftatrialappendageexclusioninatrialfibrillationpatientswithabsolutecontraindicationtooralanticoagulationtherapy |