title: Thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation.
abstract: OBJECTIVE
  This study sought to evaluate thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation (AF).
  
  
  BACKGROUND
  Closing the left atrial appendage (LAA) is an efficacious alternative to oral anticoagulation as prevention against AF-induced thromboembolism, provided that the procedure is safe and complete.
  
  
  METHODS
  Thirty patients (mean age, 74 ± 5.0 years) who had had thromboembolisms were selected. A subgroup of 21 patients (mean age, 75 years; mean CHA2DS2 VASc score, 4.5) urgently needed an alternative treatment to anticoagulation: warfarin was contraindicated due to hemorrhagic side effects in 13, the international normalized ratio was uncontrollable in 7, and transient ischemic attacks had developed immediately after the warfarin dose was reduced for oncological treatment in 1. The LAA was thoracoscopically excised with an endoscopic cutter.
  
  
  RESULTS
  Thoracoscopic appendectomy (mean operating time, 32 min, switched to mini-thoracotomy in 2 cases) led to no mortality and no major complications. Three-month post-operative 3-dimensional enhanced computed tomography, performed with patients' consent, confirmed the completeness of the appendectomy. Patients have been followed for 1 to 38 months (mean, 16 ± 9.7 months [18 ± 9.4 months for the subgroup]). One patient died of breast cancer 28 months after surgery. Despite discontinued anticoagulation, no patients have experienced recurrence of thromboembolism.
  
  
  CONCLUSIONS
  Thoracoscopic stand-alone appendectomy is potentially safe and may allow surgeons to achieve relatively simple, complete LAA closure. Further experience may demonstrate this technique to be a viable option for thromboembolism prevention in nonvalvular AF.
authors: Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo Japan. Electronic address: toshiya_ootsuka@tmhp.jp.
authors: Toshiya
authors: T
authors: Ohtsuka
authors: Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo Japan.
authors: Mikio
authors: M
authors: Ninomiya
authors: Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo Japan.
authors: Takahiro
authors: T
authors: Nonaka
authors: Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo Japan.
authors: Motoyuki
authors: M
authors: Hisagi
authors: Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Takahiro
authors: T
authors: Ota
authors: Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Toru
authors: T
authors: Mizutani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications*; D000075202:Contraindications; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control; D013906:Thoracoscopy; D013923:Thromboembolism / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants