The influence of the left atrial appendage shape on the results of thoracoscopic  AF ablation of atrial fibrillation

Amiran Sh. Revishvili , Vadim A. Popov , Egor S. Malyshenko, Maksim M. Anishchenko, Sirarpi S. Petrosyan, Madina W. Kadirowa.

A.V. Vishnevsky National Medical Research Center of Surgery Moscow, Russian Federation

Objective.  LAA  exclusion using an endostapler is one of the options for this procedure during thoracoscopic ablation (TSA) of AF 

Methods: The results of LAA endostapler LAA exclusion  were analyzed in 307 patients undergoing TSA of AF. Paroxysmal AF was noted in 129 patients (42%) and non-paroxysmal AF - in 178 (58%). The average CHA2DS3-VASc - 2.5±1.2 points; HAS-BLED - 1.2±0.6. 25 patients (8.1%) had previously a stroke. According to the Y.Wang classification all patients were divided into 4 groups based on LAA shape. G1 (chicken wing) - 101 (32.9%), G2 (cauliflower) - 45 (14.7%),  G3 (windsock) - 74 (24.1%),  G4 (cactus) - 87 (28.3%). 

Results: There were no cases of  surgical complication during procedure.  A successful procedure was achieved with a residual stump size of less than 10 mm. No significant difference in the effectiveness of LAA amputation was found depending on the shape. In all cases, it was possible to achieve complete amputation of  LAA. In some cases, an additional endostapler was used. The most frequent use of additional amputation was in G1 and G2 - 19 (18.8%) and 8 (11.8%). Sinus rhythm at discharge was observed in 94% (95/101) of patients in G1, 93.3% (42/45) in G2, 95.9% (71/74) in G3, and 91.9% (80/87) in G4.

Conclusions:  LAA exclusion with an endostapler is a simple and safe procedure that does not depend on the shape of LAA. No direct relationship was established between the shape of LAA and the frequency of sinus rhythm at discharge.