title: Thoracoscopic Occlusion of the Left Atrial Appendage.
abstract: OBJECTIVE
  Left atrial appendage (LAA) plays a crucial role in the etiopathogenesis and the prevention of the stroke in patients with nonvalvular atrial fibrillation (AF). This paper presents our first experience with thoracoscopic LAA occlusion using an external clip.
  
  
  METHODS
  We performed a total of 30 LAA occlusions with the AtriClip from left thoracoscopy approach during the period from July 2012 to July 2013. AtriClip was implanted during the bilateral thoracoscopic radiofrequency (RF) as part of left atrial ablation procedure.
  
  
  RESULTS
  Among the 30 procedures, AtriClip was once periprocedurally partially positioned. In the remaining procedures, the implantation was successful without complications. Of the 30 patients, 29 underwent transesophageal echocardiography and computer tomography examination at 3 months after the procedure. Apart from the patient with the partial clip placement, a residual pouch of 18 mm was detected in another patient. In the remaining group (28/30 patients, 93%), the exclusion was complete. No migration or any other clip implantation-related complications occurred during the follow-up. None of the patients experienced an embolization event.
  
  
  CONCLUSIONS
  Endoscopic AtriClip implantation appears to be a reproducible and safe method of LAA occlusion, with a minimal risk and a high efficiency. In our opinion, the AtriClip implantation is a reasonable part of thoracoscopic AF treatment and should be considered as an alternative tool for stroke risk reduction in patients with AF.
authors.affiliation: From the *Department of Cardiac Surgery, Hospital of Ceske Budejovice, Ceske Budejovice, Czech Republic; and †Faculty of Health and Social Studies, University of South Bohemia, Ceske Budejovice, Czech Republic.
authors.forename: Ales
authors.initials: A
authors.lastname: Mokracek
authors.forename: Vojtech
authors.initials: V
authors.lastname: Kurfirst
authors.forename: Alan
authors.initials: A
authors.lastname: Bulava
authors.forename: Jiri
authors.initials: J
authors.lastname: Hanis
authors.forename: Richard
authors.initials: R
authors.lastname: Tesarik
authors.forename: Ladislav
authors.initials: L
authors.lastname: Pesl
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D020521:Stroke / Q000517:prevention & control; D013906:Thoracoscopy / Q000379:methods*; D013923:Thromboembolism / Q000503:physiopathology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome