Robotic Endoscopic Left Atrial Appendage Closure

The left atrial appendage is an pocket attached to the left atrial in which clot can form during atrial fibrillation

The left atrial appendage is a pocket attached to the left atrial in which clot can form during atrial fibrillation

Although most patients with atrial fibrillation referred for surgery should probably get a MAZE procedure (ablation of the abnormal heart rhythm, in select cases patients need to simply have the left atrial appendage removed or “excluded” from the circulation.  The left atrial appendage is an outpouching of the left atrium (one of the four chambers of the heart) in which clot can form with atrial fibrillation.  This clot can break off and go to the brain causing strokes, the dreaded complication of atrial fibrillation.  Some patients are not candidates for anticoagulation (blood thinners) and may also benefit.

While there are many catheter-based procedures in development and in use, endoscopic robotic closure is quite simple and easy.  The procedure usually takes no more than 1 hour and patients can leave the hospital the next day barring unusual circumstances.  The procedure involves 4 tiny incisions in the left chest (three 8 mm ports for the robotic instruments and one 12mm port to place the clip into the chest used to exclude the appendage.  Unlike many of the catheter-based procedures, there is no foreign body remaining inside the heart, its all external to the heart.

This depicts one type of device that can be used to clip the left atrial appendage robotically

Here the clip device is shown occluding the left atrial appendage prior to release

Here the clip device is shown occluding the left atrial appendage prior to release

The procedure is “off-pump” meaning no heart-lung bypass is used.  The only relative contraindications to the procedure would be actual clot within the appendage (which could break off and cause a stroke during the procedure) or dense adhesions in the left chest (scar tissue from prior infection or surgery).  This procedure can also be done with an endoscopic robotic limited MAZE procedure that involves essentially what’s called a pulmonary vein isolation.  While effective only for “paroxysmal atrial fibrillation” (which comes and goes on its own), it’s not so good for persistent atrial fibrillation.  A standard full MAZE should be considered in these cases.  For information on this procedure also performed robotically click Here.

T. Sloane Guy, MD

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