%0 Online Multimedia %A Jett, G. Kimble %A Leal, Andreas %D 2020 %T Robotic-Assisted Left Atrial Appendage Exclusion with the PRO•V AtriCure Atrial Clip %U https://ctsnet.figshare.com/articles/media/Robotic-Assisted_Left_Atrial_Appendage_Exclusion_with_the_PRO_V_AtriCure_Atrial_Clip/12723869 %R 10.25373/ctsnet.12723869.v1 %2 https://ctsnet.figshare.com/ndownloader/files/24085844 %K Cardiac %K electrophysiology %K arrhythmia %K Surgery %X
Atrial fibrillation is the most common cardiac arrhythmia, affecting more than 33 million individuals worldwide (1). Anticoagulation is frequently needed to decrease the risk of stroke, but nearly 20-40% of patients at risk of stroke do not receive anticoagulation due to contraindication, bleeding, or patient/physician preferences (2, 3). Greater than 90% of cardiac emboli in nonvalvular atrial fibrillation originate in the left atrial appendage (4). The WATCHMAN™ device has been extensively studied and has emerged as an option for left atrial appendage (LAA) closure in those patients who cannot take anticoagulation, and they have had excellent results (5). Not every patient is a candidate for the WATCHMAN™ device, and the patient still requires anticoagulation for at least 45 days to allow for device endothelialization. In addition, device related thrombus (DRT) has been observed in >3% of patients with the WATCHMAN™ device (6).
Open and minimally invasive techniques have been employed for surgical LAA occlusion. The current European Society of Cardiology and American Heart Association/American College of Cardiology guidelines suggest that surgical excision/exclusion of the LAA may be considered in patients undergoing cardiac surgery or thoracoscopic atrial fibrillation surgery (grade IIB) (7). The AtriClip and AtriClip Pro (Atricure, West Chester, Ohio) have been demonstrated to have high success rates in the EXCLUDE trial (8). Closure efficacy of the atrial clip applied via total thoracoscopic approach has recently been demonstrated to have a 93.9% closure rate confirmed by angiography (9).
This video demonstrates the technique of robotic-assisted LAA occlusion with an atrial clip. The patient was an 80-year-old woman with a history of CABG x 3 1996. She had a pacemaker inserted for syncope and chronic atrial fibrillation in 2018. She was anticoagulated and had multiple gastrointestinal bleeds. She was not a candidate for the WATCHMAN™ device due to the need for temporary anticoagulation. CTA of her heart demonstrated LAA ostium = 27 x 19 mm and LAA tilted depth = 29.7 mm. She underwent robotic-assisted left atrial appendage exclusion and was discharged home two days later.
References
G. Kimble Jett is a speaker and proctor for Intuitive Surgical, Inc.
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