Concomitant Left Atrial Appendage Amputation Using a Stapler during Cardiovascular Surgery

Masakazu Aoki＊	Hiroshi Furuhata＊	Toshikazu Shimizu＊
Riki Sumiyoshi＊	Hiroshi Nagano＊	Hideki Morita＊
Hiromasa Kawaura＊＊

（Department of Cardiovascular Surgery, Saitama Red Cross Hospital＊, Saitama, Japan, and Department of Emergency, Saitama Red Cross Hospital＊＊, Saitama, Japan）

Objective:The objective of this study was to assess the safety and efficacy of left atrial appendage（LAA）amputation during cardiovascular surgery. Methods：Fifty-seven patients underwent LAA amputation using a stapler from 2016 to 2017. The presence of remnant LAA was estimated by transesophageal echocardiography（TEE). Results:All LAA amputations were performed with the heart beating, without collapse. Additional amputation for remnant LAA was required in 14 patients. Sutures were needed to control bleeding in 7 patients. There was one case in which the coronary artery ended up being clamped with the LAA. The average duration for LAA amputation was 6.1±3.2（1.5-15.2）min. There were 25 cases with postoperative atrial fibrillation（POAF), one case of cerebral infarction without POAF and one case of re-exploration for bleeding. Three patients died during hospitalization. Conclusion:LAA amputation using a stapler does not require cardiac arrest, and rarely requires an extended operation time. However, sufficient caution is required as there is the possibility that the coronary artery is obstructed and that remnant LAA is present.

 

Jpn. J. Cardiovasc. Surg. 48:97-102（2019）

Keywords：postoperative atrial fibrillation;cardiogenic cerebral embolism;left atrial appendage closure;stapler