Totally endoscopic robotic left atrial appendage closure demonstrates high success rate

Alison F. Ward, Robert M. Applebaum, Nana Toyoda, Ans Fakiha, Peter J. Neuburger, Jennie Ngai, Robert G. Nampiaparampil, David W. Yaffee, Didier F. Loulmet, Eugene A. Grossi

Research output: Contribution to journalArticle

Abstract

Objective: In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates. Methods: Before robotic mitral repair, patients underwent RLAAC; the base of the LAA was oversewn using a running 4-0 polytetrafluoro-ethylene suture in two layers. Postoperatively, the LAAwas interrogated in multiple TEE views. Incomplete closure was defined as any flow across the LAA suture line or a residual stump of greater than 1 cm. Results: Seventy-nine consecutive patients underwent RLAAC; no injuries occurred. On postrepair TEE, 73 of 79 patients had LAAs visualized well enough to thoroughly evaluate. Successful ligation was confirmed in 64 (87.7%) of 73 patients. Seven patients (9.6%) had small jet flow into the LAA; no residual stumps were noted. Two patients (2.7%) had undetermined flow. Conclusions: We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7%) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5%) and staple closure (72.7%). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients.

Original languageEnglish (US)
Pages (from-to)46-49
Number of pages4
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2017

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Atrial Appendage
Robotics
Sutures
Atrial Fibrillation
Stroke
Mitral Valve
Ligation
Equipment and Supplies

Keywords

  • Atrial fibrillation
  • Left atrial appendage
  • Robotic surgery
  • Stroke prevention

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Totally endoscopic robotic left atrial appendage closure demonstrates high success rate. / Ward, Alison F.; Applebaum, Robert M.; Toyoda, Nana; Fakiha, Ans; Neuburger, Peter J.; Ngai, Jennie; Nampiaparampil, Robert G.; Yaffee, David W.; Loulmet, Didier F.; Grossi, Eugene A.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 12, No. 1, 01.01.2017, p. 46-49.

Research output: Contribution to journalArticle

Ward, AF, Applebaum, RM, Toyoda, N, Fakiha, A, Neuburger, PJ, Ngai, J, Nampiaparampil, RG, Yaffee, DW, Loulmet, DF & Grossi, EA 2017, 'Totally endoscopic robotic left atrial appendage closure demonstrates high success rate', Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, vol. 12, no. 1, pp. 46-49. https://doi.org/10.1097/IMI.0000000000000330
Ward, Alison F. ; Applebaum, Robert M. ; Toyoda, Nana ; Fakiha, Ans ; Neuburger, Peter J. ; Ngai, Jennie ; Nampiaparampil, Robert G. ; Yaffee, David W. ; Loulmet, Didier F. ; Grossi, Eugene A. / Totally endoscopic robotic left atrial appendage closure demonstrates high success rate. In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2017 ; Vol. 12, No. 1. pp. 46-49.
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abstract = "Objective: In patients with atrial fibrillation, 90{\%} of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates. Methods: Before robotic mitral repair, patients underwent RLAAC; the base of the LAA was oversewn using a running 4-0 polytetrafluoro-ethylene suture in two layers. Postoperatively, the LAAwas interrogated in multiple TEE views. Incomplete closure was defined as any flow across the LAA suture line or a residual stump of greater than 1 cm. Results: Seventy-nine consecutive patients underwent RLAAC; no injuries occurred. On postrepair TEE, 73 of 79 patients had LAAs visualized well enough to thoroughly evaluate. Successful ligation was confirmed in 64 (87.7{\%}) of 73 patients. Seven patients (9.6{\%}) had small jet flow into the LAA; no residual stumps were noted. Two patients (2.7{\%}) had undetermined flow. Conclusions: We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7{\%}) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5{\%}) and staple closure (72.7{\%}). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients.",
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T1 - Totally endoscopic robotic left atrial appendage closure demonstrates high success rate

AU - Ward, Alison F.

AU - Applebaum, Robert M.

AU - Toyoda, Nana

AU - Fakiha, Ans

AU - Neuburger, Peter J.

AU - Ngai, Jennie

AU - Nampiaparampil, Robert G.

AU - Yaffee, David W.

AU - Loulmet, Didier F.

AU - Grossi, Eugene A.

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N2 - Objective: In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates. Methods: Before robotic mitral repair, patients underwent RLAAC; the base of the LAA was oversewn using a running 4-0 polytetrafluoro-ethylene suture in two layers. Postoperatively, the LAAwas interrogated in multiple TEE views. Incomplete closure was defined as any flow across the LAA suture line or a residual stump of greater than 1 cm. Results: Seventy-nine consecutive patients underwent RLAAC; no injuries occurred. On postrepair TEE, 73 of 79 patients had LAAs visualized well enough to thoroughly evaluate. Successful ligation was confirmed in 64 (87.7%) of 73 patients. Seven patients (9.6%) had small jet flow into the LAA; no residual stumps were noted. Two patients (2.7%) had undetermined flow. Conclusions: We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7%) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5%) and staple closure (72.7%). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients.

AB - Objective: In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates. Methods: Before robotic mitral repair, patients underwent RLAAC; the base of the LAA was oversewn using a running 4-0 polytetrafluoro-ethylene suture in two layers. Postoperatively, the LAAwas interrogated in multiple TEE views. Incomplete closure was defined as any flow across the LAA suture line or a residual stump of greater than 1 cm. Results: Seventy-nine consecutive patients underwent RLAAC; no injuries occurred. On postrepair TEE, 73 of 79 patients had LAAs visualized well enough to thoroughly evaluate. Successful ligation was confirmed in 64 (87.7%) of 73 patients. Seven patients (9.6%) had small jet flow into the LAA; no residual stumps were noted. Two patients (2.7%) had undetermined flow. Conclusions: We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7%) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5%) and staple closure (72.7%). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients.

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KW - Stroke prevention

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