title: Stand-alone totally thoracoscopic left atrial appendage exclusion using a novel clipping system in patients with high risk of stroke - initial experience and literature review.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and it is strongly associated with stroke. Left atrial appendage (LAA) is considered to be the most often source of thrombotic material. In recent decades a number surgical, percutaneous and hybrid approaches for LAA occlusion have been described revealing very different level of success and showing a variety of challenges associated with this matter. We present the first Polish experience with the stand-alone totally thoracoscopic LAA exclusion using novel clipping system.
  
  
  METHODS
  Four patients (one male) in mean age of 74 (± 13) years with long-standing persistent and chronic AF were admitted for totally thoracoscopic LAA exclusion. All patients had significant comorbidities and the history of the oral anticoagulation intolerance or suboptimal/unstable level (CHA2DS2-VASC > 5, HAS_BLED > 3). Three procedures were performed through totally thoracoscopic access. In one patient due to massive adhesions in the left pleura we performed minithoracotomy in fourth left intercostal space. In two months follow-up we observed no mortality, no strokes and no bleedings.
  
  
  RESULTS
  In all patient total exclusion of LAA with no residual remnant was confirmed. The "skin-to-skin" procedural time took on average 40, minimum 20 minutes. Patients were extubated directly or within two hours after procedure. All patients were discharged early in a good condition.
  
  
  CONCLUSIONS
  Our initial first experience with the novel totally thoracoscopic clipping system for stand-alone LAA exclusion is very promising showing very high efficacy and good safety profile.
authors: Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland; Pulaski University of Technology and Humanities, Radom, Poland; Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
authors: Piotr
authors: P
authors: Suwalski
authors: Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Anna
authors: A
authors: Witkowska
authors: Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Dominik
authors: D
authors: Drobiński
authors: Department of Noninvasive Cardiology and Arterial Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Joanna
authors: J
authors: Rozbicka
authors: Department of Noninvasive Cardiology and Arterial Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Sławomir
authors: S
authors: Sypuła
authors: Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Irena
authors: I
authors: Liszka
authors: Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Radosław
authors: R
authors: Smoczyński
authors: Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Jakub
authors: J
authors: Staromłyński
authors: Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Irena
authors: I
authors: Walecka
authors: Department of Noninvasive Cardiology and Arterial Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Dariusz
authors: D
authors: Kosior
keywords: LAA occlusion; atrial fibrillation; totally thoracoscopic