Medical Science: Recent Advances and Applications Vol. 6

Abstract

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.