"One-stop" left atrial appendage clipping combined with transcatheter aortic valve replacement for patients with atrial fibrillation and aortic valve disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Zhaolei ¹ ,  MEI Ju ¹ , TANG Min ¹ , HUANG Jianbing ¹ , DING Fangbao ¹ , LIU Hao ¹ , SHEN Sai’e ²

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;
2. Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;

Corresponding author：

MEI Ju, Email: ju_mei63@126.com

Keywords：

"One-stop"; left atrial appendage clipping; transcatheter aortic valve replacement; atrial fibrillation

DOI：

10.7507/1007-4848.202112065

Video：

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Objective To summarize the experience and efficacy of "one-stop" left atrial appendage clipping (LAAC) combined with transcatheter aortic valve replacement (TAVR) for patients with atrial fibrillation (AF) and aortic valve disease. Methods From April 2018 to March 2021, 16 patients with AF and severe aortic valve disease underwent "one-stop" LAAC and TAVR in our department. All patients had long-standing persistent AF. There were 10 males and 6 females with an average age of 77.2±6.2 years. CHA2DS2-VASc score was 4.4±0.8 points, and HAS-BLED score was 3.5±0.7 points. Results All patients successfully underwent "one-stop" LAAC combined with TAVR. There was no death during perioperative and follow-up periods. The length of the left atrial appendage base measured during the operation was 37.8±3.5 mm. The types of atrial appendage clip were 35 mm (n=3), 40 mm (n=8) and 45 mm (n=5). The time required for clipping the left atrial appendage (from skin cutting to skin suturing) was 25.7±3.8 min. There was no stroke or bleeding of important organs during the perioperative period. The average hospital stay was 6.8±2.0 d. The follow-up time was 19.6±10.1 months, during which there was no patient of cerebral hemorrhage or cerebral infarction. During the administration of warfarin, 2 patients had subcutaneous ecchymosis and 1 patient had gingival bleeding. Conclusion "One-stop" LAAC combined with TAVR can be safely and effectively used to treat AF and aortic valve disease patients with high risk of thromboembolism and anticoagulant bleeding. The early and middle-term curative effect is satisfactory.

Citation： JIANG Zhaolei, MEI Ju, TANG Min, HUANG Jianbing, DING Fangbao, LIU Hao, SHEN Sai’e. "One-stop" left atrial appendage clipping combined with transcatheter aortic valve replacement for patients with atrial fibrillation and aortic valve disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 560-564. doi: 10.7507/1007-4848.202112065 Copy

1.	Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: A review. JAMA, 2021, 325(24): 2480-2494.
2.	Kumar V, Sandhu GS, Harper CM, et al. Transcatheter aortic valve replacement programs: Clinical outcomes and developments. J Am Heart Assoc, 2020, 9(8): e015921.
3.	Okuno T, Hagemeyer D, Brugger N, et al. Valvular and nonvalvular atrial fibrillation in patients undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2020, 13(18): 2124-2133.
4.	Tarantini G, Mojoli M, Windecker S, et al. Prevalence and impact of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: An analysis from the SOURCE XT Prospective Multicenter Registry. JACC Cardiovasc Interv, 2016, 9(9): 937-946.
5.	Parikh K, Dizon J, Biviano A. Revisiting atrial fibrillation in the transcatheter aortic valve replacement era. Interv Cardiol Clin, 2018, 7(4): 459-469.
6.	Tarantini G, Mojoli M, Urena M, et al. Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: Epidemiology, timing, predictors, and outcome. Eur Heart J, 2017, 38(17): 1285-1293.
7.	姜兆磊, 梅举, 汤敏, 等. 经右胸微创外科治疗成人房间隔缺损合并心房颤动. 中国胸心血管外科临床杂志, 2018, 25(2): 133-137.
8.	Ammar A, Elbatran AI, Wijesuriya N, et al. Management of atrial fibrillation after transcatheter aortic valve replacement: Challenges and therapeutic considerations. Trends Cardiovasc Med, 2021, 31(6): 361-367.
9.	Abdul-Jawad Altisent O, Durand E, Muñoz-García AJ, et al. Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2016, 9(16): 1706-1717.
10.	Bedeir K, Holmes DR, Cox JL, et al. Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 153(5): 1097-1105.
11.	Caliskan E, Sahin A, Yilmaz M, et al. Epicardial left atrial appendage AtriClip occlusion reduces the incidence of stroke in patients with atrial fibrillation undergoing cardiac surgery. Europace, 2018, 20(7): e105-e114.
12.	Emmert MY, Puippe G, Baumüller S, et al. Safe, effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery: First long-term results from a prospective device trial. Eur J Cardiothorac Surg, 2014, 45(1): 126-131.
13.	Tiver KD, Quah J, Lahiri A, et al. Atrial fibrillation burden: An update-the need for a CHA2DS2-VASc-AFBurden score. Europace, 2021, 23(5): 665-673.
14.	Kaplan RM, Koehler J, Ziegler PD, et al. Stroke risk as a function of atrial fibrillation duration and CHA2DS2-VASc score. Circulation, 2019, 140(20): 1639-1646.
15.	Roldán V, Marín F, Manzano-Fernández S, et al. The HAS-BLED score has better prediction accuracy for major bleeding than CHADS2 or CHA2DS2-VASc scores in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol, 2013, 62(23): 2199-2204.
16.	Goldman ME, Pearce LA, Hart RG, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: Ⅰ. Reduced flow velocity in the left atrial appendage (the stroke prevention in atrial fibrillation [SPAF-Ⅲ] study). J Am Soc Echocardiogr, 1999, 12(12): 1080-1087.
17.	Ono K, Iwama M, Kawasaki M, et al. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation. Cardiovasc Ultrasound, 2012, 10: 50.
18.	Onalan O, Crystal E. Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation. Stroke, 2007, 38(2 Suppl): 624-630.
19.	January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
20.	黄从新, 张澍, 黄德嘉, 等. 左心耳干预预防心房颤动患者血栓栓塞事件: 目前的认识和建议-2019. 中国心脏起搏与心电生理杂志, 2019, 33(5): 385-401.
21.	Rosati F, de Maat GE, Valente MAE, et al. Surgical clip closure of the left atrial appendage. J Cardiovasc Electrophysiol, 2021, 32(10): 2865-2872.
22.	姜兆磊, 汤敏, 梅举, 等. 高龄冠心病合并心房颤动患者行非体外循环冠状动脉旁路移植术中左心耳处理的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(2): 186-190.

1. Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: A review. JAMA, 2021, 325(24): 2480-2494.
2. Kumar V, Sandhu GS, Harper CM, et al. Transcatheter aortic valve replacement programs: Clinical outcomes and developments. J Am Heart Assoc, 2020, 9(8): e015921.
3. Okuno T, Hagemeyer D, Brugger N, et al. Valvular and nonvalvular atrial fibrillation in patients undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2020, 13(18): 2124-2133.
4. Tarantini G, Mojoli M, Windecker S, et al. Prevalence and impact of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: An analysis from the SOURCE XT Prospective Multicenter Registry. JACC Cardiovasc Interv, 2016, 9(9): 937-946.
5. Parikh K, Dizon J, Biviano A. Revisiting atrial fibrillation in the transcatheter aortic valve replacement era. Interv Cardiol Clin, 2018, 7(4): 459-469.
6. Tarantini G, Mojoli M, Urena M, et al. Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: Epidemiology, timing, predictors, and outcome. Eur Heart J, 2017, 38(17): 1285-1293.
7. 姜兆磊, 梅举, 汤敏, 等. 经右胸微创外科治疗成人房间隔缺损合并心房颤动. 中国胸心血管外科临床杂志, 2018, 25(2): 133-137.
8. Ammar A, Elbatran AI, Wijesuriya N, et al. Management of atrial fibrillation after transcatheter aortic valve replacement: Challenges and therapeutic considerations. Trends Cardiovasc Med, 2021, 31(6): 361-367.
9. Abdul-Jawad Altisent O, Durand E, Muñoz-García AJ, et al. Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2016, 9(16): 1706-1717.
10. Bedeir K, Holmes DR, Cox JL, et al. Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 153(5): 1097-1105.
11. Caliskan E, Sahin A, Yilmaz M, et al. Epicardial left atrial appendage AtriClip occlusion reduces the incidence of stroke in patients with atrial fibrillation undergoing cardiac surgery. Europace, 2018, 20(7): e105-e114.
12. Emmert MY, Puippe G, Baumüller S, et al. Safe, effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery: First long-term results from a prospective device trial. Eur J Cardiothorac Surg, 2014, 45(1): 126-131.
13. Tiver KD, Quah J, Lahiri A, et al. Atrial fibrillation burden: An update-the need for a CHA2DS2-VASc-AFBurden score. Europace, 2021, 23(5): 665-673.
14. Kaplan RM, Koehler J, Ziegler PD, et al. Stroke risk as a function of atrial fibrillation duration and CHA2DS2-VASc score. Circulation, 2019, 140(20): 1639-1646.
15. Roldán V, Marín F, Manzano-Fernández S, et al. The HAS-BLED score has better prediction accuracy for major bleeding than CHADS2 or CHA2DS2-VASc scores in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol, 2013, 62(23): 2199-2204.
16. Goldman ME, Pearce LA, Hart RG, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: Ⅰ. Reduced flow velocity in the left atrial appendage (the stroke prevention in atrial fibrillation [SPAF-Ⅲ] study). J Am Soc Echocardiogr, 1999, 12(12): 1080-1087.
17. Ono K, Iwama M, Kawasaki M, et al. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation. Cardiovasc Ultrasound, 2012, 10: 50.
18. Onalan O, Crystal E. Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation. Stroke, 2007, 38(2 Suppl): 624-630.
19. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
20. 黄从新, 张澍, 黄德嘉, 等. 左心耳干预预防心房颤动患者血栓栓塞事件: 目前的认识和建议-2019. 中国心脏起搏与心电生理杂志, 2019, 33(5): 385-401.
21. Rosati F, de Maat GE, Valente MAE, et al. Surgical clip closure of the left atrial appendage. J Cardiovasc Electrophysiol, 2021, 32(10): 2865-2872.
22. 姜兆磊, 汤敏, 梅举, 等. 高龄冠心病合并心房颤动患者行非体外循环冠状动脉旁路移植术中左心耳处理的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(2): 186-190.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

"One-stop" left atrial appendage clipping combined with transcatheter aortic valve replacement for patients with atrial fibrillation and aortic valve disease

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