Intraoperative evaluation of percutaneous LARIAT left atrial appendage closure – are the adhesions present 7 years after the epicardial procedure?

One method of managing atrial fibrillation (AF) and its complications is left atrial appendage closure (LAAC). The method of choice for LAAC is the LARIAT procedure (SentreHEART, Inc., currently Atricure Inc. Redwood City, CA) – epicardial left atrial appendage (LAA) ligation via intracardiac and epicardial catherization – which was performed in over 4500 cases in the United States over the years 2011–2018 [1]. Over the years, hypotheses about LARIAT related outcomes have been confirmed by a decrease in LAA size after a month [2] and the use of anti-inflammatory drugs to minimize adhesions [3].
Here, we aim to provide additional long-term observational evidence of the validity of the model in terms of a lack of adhesions in the pericardial cavity in patients with AF who have undergone LAAC with LARIAT.
A 75-year-old man with a body mass index of 29.96, a CHA2DS2-VASc of 8 and a short history of severe aortic stenosis (AS) with mild regurgitation (New York Heart Association II/III), permanent AF, after LAAC with LARIAT (in 2014), two pre-LAAC strokes (2001 and 2006), laminectomy of the lumbar spine, transurethral resection of the prostate, hypertension, dyslipidemia and impaired glucose tolerance, was admitted in January 2021 because of dyspnea. Transthoracic echocardiography (TTE) revealed a physiological amount of fluid in the pericardial sac, enlargement of both atria with estimated LA size of 45 mm, right ventricular hypertrophy without signs of pulmonary hypertension, left ventricle (LV) muscle hypertrophy with assessed size of 37 mm and left ventricle ejection fraction up to 60% and severe AS with mild regurgitation with aortic valve area of 0.6–0.7 cm2 and transvalvular mean gradient 42 mmHg. Additionally, mild mitral regurgitation and moderate tricuspid regurgitation were confirmed. The patient was qualified for an isolated aortic valve replacement (AVR) procedure by the Heart Team. In August 2021, the patient was admitted to the Cardiac Surgery Department. A pre-operative follow-up TTE was performed (Figure 1). The procedure was conducted with a complete median sternotomy and standard cardiopulmonary bypass (CPB) technique with ascending aorta and two-stage venous cannulation, epicardial electrode placement, hemodilution, systemic mild hypothermia (32.8°C) and membrane oxygenation, and cold myocardial protection with antegrade crystalloid cardioplegia. There were no adhesions present on the entire surface of the anterior...


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