Thoracoscopic left atrial appendage (LAA) occlusion is an alternative treatment for
stroke prevention in patients with atrial fibrillation. Prospective study comparing
thoracoscopic LAA occlusion and warfarin therapy is still lacking. The goal of this
prospective cohort study was to assess the safety and efficacy of thoracoscopic LAA
occlusion for stroke prevention in patients with nonvalvular atrial fibrillation compared
with long-term warfarin therapy. Four hundred and ninety-two nonvalvular atrial fibrillation
patients were enrolled. Two hundred and fifty-seven patients were treated with thoracoscopic
LAA occlusion and 235 with long-term warfarin therapy. At 24 months, the rate of the
first efficacy endpoint (composite of stroke, systemic embolism, and death) was 0.018
in the surgical group versus 0.043 in the warfarin group (p = 0.033). The rate of
the second efficacy endpoint (stroke and systemic embolism excluding the first 7 days
after procedure) was 0.010 versus 0.034 (p = 0.019). The rate of the first safety
endpoint of bleeding was 0.016 versus 0.044 (p = 0.022). In conclusion, this study
showed that thoracoscopic LAA occlusion was superior to warfarin for stroke prevention.
The surgical group also had significantly lower bleeding risk. The incidence of surgical
complications was low, and all occurred in hospital without causing serious outcomes.
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Article info
Publication history
Published online: September 26, 2018
Accepted:
September 21,
2018
Received in revised form:
September 15,
2018
Received:
August 17,
2018
Identification
Copyright
© 2018 Published by Elsevier Inc.
