Clin Surg | Volume 3, Issue 1 | Research Article | Open Access

‘‘Effectiveness of Suture Closure of Left Atrial Appendage to Prevent Thromboemboli in Atrial Fibrillation among Patients Undergoing Bio-Prosthetic Mitral Valve Replacement”

Elayouty HD1*, Hassan HS1, Abdal Hafeez SAS1, Faisal HS1 and Sami AT2

1Department of Cardiothoracic Surgery, Suez Canal University, Egypt
2Department of Cardiothoracic Surgery, Ain Shams University, Egypt

*Correspondance to: Hamdy D Elayouty 

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Abstract

Objectives: Atrial fibrillation is the most common sustained arrhythmia. Patients with atrial fibrillation have a fivefold higher risk of thrombo-embolism and stroke. Aim of current study is to assess effectiveness of intra operative suture closure of left atrial appendage in prevention of thrombo-embolism.Methods: 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 left appendage with 4/o polypropylene suture. Postoperatively, they received anticoagulants for 90 days. The control group included 200 patients. They didn`t 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.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 10patients (5%). Postoperative thrombi or thrombo-emboli weren’t reported. Control group 200 patients, 101(51%) females, mean age 30 ± 1.02 years. Intra-operatively, thrombi in appendage were extracted in 8 patients (4%). Trans-esophageal echocardiography showed left appendage-thrombi in six patients (P-value 0.0001) and one case of thrombo embolism was reported.Conclusion: Intra-operative suture closure of left atrial appendage kept patients, having atrial fibrillation, free of thrombo embolic events in contradistinction to the control group. This technique is effective and reproducible.

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Citation:

Elayouty HD, Hassan HS, Abdal Hafeez SAS, Faisal HS, Sami AT. ��Effectiveness of Suture Closure of Left Atrial Appendage to Prevent Thromboemboli in Atrial Fibrillation among Patients Undergoing Bio-Prosthetic Mitral Valve Replacement�. Clin Surg. 2018; 3: 1886.

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