Reoperative planning of thoracoscopic amputation of the left atrium appendage in atrial fibrillation

Atrial fibrillation is the most common atrial tachyarrhythmia worldwide. The risks of systemic thromboembolic events are significantly increased in patients with atrial fibrillation. In this patient group, it is thought that up to 95% of the thrombus is thought to be localised in the left atrial appendage. An important problem of modern arrhythmology is the search for optimal and effective methods of prevention of thromboembolic events in atrial fibrillation. Although the therapeutic methods are proven to be highly effective, this method has a number of limitations and contraindications in lifelong administration.
Surgical isolation or exclusion of the auricle of the left appendage is an alternative option, but this procedure is only possible as a simultaneous procedure in open cardiac surgery.
Occluder implantation is a promising direction in isolation of the left atrial appendage, but has a high dependence on the anatomical structure of the anatomy of the latter and requires the administration of antiaggregants in the postoperative period.
Due to high traumatic nature of open surgical interventions and technical difficulties of occluder implantation, methods of isolation of the left atrial appendage from the systemic blood flow from minimally invasive accesses have been developed. Video-assisted thoracoscopic ablations are not only a promising way to perform epicardial ablation, but also offer the possibility of performing a one-stage left atrial appendage exclusion.
An unresolved challenge of minimally invasive surgical isolation of the left atrial appendage is its detailed visualisation at the surgical planning stage. Computed tomography with contrast has a high resolution, which together with the ability to build three-dimensional models allows a more accurate selection of the size, type and optimal position of the occluding device for the patient according to his anatomical features. Thus, the main objective of the presented report was to describe the role of contrast-enhanced computed tomography at the planning stage of thoracoscopic left atrial appendage endostapler amputation to improve the safety and efficacy of the procedure.

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