Background: Atrial fibrillation (AF) is the most common sustained arrhythmia. The incidence of Left Atrial Thrombi (LAT) was significantly higher in patients with atrial fibrillation (14%) compared with patients in sinus rhythm (1%; P<0.001). Patients with AF have a fivefold higher risk of stroke. Cerebral thromboembolism is the number one cause of long-term disability and the third leading cause of death in patients with AF.
Objective: The aim of the study is to
assess the effectiveness of intraoperative suture closure of the left atrial
appendage in the prevention of thromboembolism.
Methods: In this study, 400 patients
underwent bio-prosthetic mitral valve replacement between 2011 and 2017.
Pre-operatively, they had rheumatic mitral valve disease and atrial fibrillation
with controlled heart rate. The study group included 200 cases.
Intra-operatively, each one had continuous suturing of margins of the mouth of
the left appendage with 4/o polypropylene suture. Postoperatively, they
received anticoagulants for 90 days. The control group, comprising another 200
patients, did not have such suturing of appendage. They received indefinite
anticoagulants. Follow-up continued for 78 months and included clinical
examination every 3 months and trans-esophageal echocardiography every year.
Clinical profiles of the patients were compared using the Fisher exact test.
All data were analysed using SPSS software version 11.0.
Results: Study group included 200
patients 109 (54%) females, mean age of 29 ± 2.1 years. Suturing of the margins
of atrial appendage needed 4 ± 0.25 minutes to be conducted after incising the
left atrium and examining the appendage. Atrial thrombi were removed from the
appendage in 10 patients (5%). Postoperative thrombi or thrombo-emboli were not
reported. Control group 200 patients, 101(51%) females, mean age 30 ± 1.02
years. Intra-operatively, thrombi in appendages were extracted in 8 patients
(4%). Trans-esophageal echocardiography showed left appendage-thrombi in six
patients (P-value 0.0001) and one case of thromboembolism was reported. Sinus
rhythm was noticed for a mean period of 29 ± 3.5 hr postoperatively followed by
Atrial Fibrillation among all patients.
Conclusion: Atrial Fibrillation, being a
complex type of arrhythmia, is still not thoroughly understood in many
patients. Intra-operative suture closure of left atrial appendage (LAA) kept
patients, having atrial fibrillation, free of thromboembolic events in
contradistinction to the control group. This technique is effective and
reproducible. If complete LAA occlusion can safely take place in patients
experiencing AF, it should be performed.
Author (s) Details
Elayouty HD
Department of Cardiothoracic Surgery,
Suez Canal University, Egypt.
Hassan HS
Department of Cardiothoracic Surgery,
Suez Canal University, Egypt.
Abdal Hafeez SAS
Department of Cardiothoracic Surgery,
Suez Canal University, Egypt.
Faisal HS
Department of Cardiothoracic Surgery,
Suez Canal University, Egypt.
Sami AT
Department of Cardiothoracic Surgery,
Ain Shams University, Egypt.
Ahmed Hamdy D. Elayouty
Department of Cardiothoracic Surgery,
Suez Canal University, Egypt.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v6/5229
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