Background: Oral anticoagulation (OAC) and exclusion of the left atrial appendage (LAA) greatly reduce the risk of thromboembolic events in patients with atrial fibrillation (AF). Patients with known intolerance to OAC, however, have limited options for transcatheter management of both AF and the LAA. Previous investigation has suggested that minimally invasive LAA exclusion via epicardial clip placement is feasible without OAC but is associated with variable increase in morbidity and mortality. This study aims to assess the safety and long-term efficacy of robotic-assisted LAA exclusion (RA-LAAE) in patients intolerant to OAC.

Methods: Retrospective, single-center, analysis of patients with AF and OAC intolerance that underwent RA-LAAE between 2019 and 2023. The primary objective assessed was freedom from cerebral and systemic thromboembolic events at 90 days and 1 year. Secondary outcomes included radiographic assessment of successful LAAE, rates of readmission, and overall mortality.

Results: Twenty-nine patients (mean age 74.6 years, 28% female), with a diagnosis of paroxysmal (48%), persistent (10%), or long-standing (41%) AF, CHA2DS2VASc 4.4±1.4, HAS-BLED 3.8±0.9, and left atrial volume index 49.1±15.2 underwent RA-LAAE. All procedures were completed successfully with an operative duration of 100±40 minutes. Postoperative length of stay was 1.7±1.3 days. Follow-up imaging at 90 days confirmed successful LAAE for all cases. MACCE within 90 days occurred in 1 (3%) patient and in no additional patients at 1 year.

Conclusions: RA-LAAE in patients intolerant to OAC appears to be safe and effective with low MACCE and mortality rates.

背景：口服抗凝药（OAC）和左心耳（LAA）闭塞可以显著降低房颤患者发生血栓栓塞事件的风险。然而，对于已知对 OAC 不耐受的患者来说，在不使用 OAC 的情况下通过经皮方法管理房颤和 LAA 的选择有限。先前的研究表明，无需 OAC 即可通过放置心外膜夹进行微创性 LAA 闭塞，但与之相关的发病率和死亡率变化较大。本研究旨在评估机器人辅助左心耳闭塞（RA-LAAE）在口服抗凝药不耐受患者中的安全性和长期疗效。

方法：回顾性分析2019年至2023年间接受 RA-LAAE 的房颤和 OAC 不耐受患者的单中心数据。主要评估目标是在 90 天及一年时无脑卒中和其他系统性血栓栓塞事件的自由度。次要结果包括 LAAE 成功的影像学评估、再住院率以及总体死亡率。

结果：29 名患者（平均年龄74.6岁，女性占28%），诊断为阵发性（48%）、持续性（10%）或长期存在（41%）房颤，CHA2DS2VASc 评分为4.4±1.4，HAS-BLED评分为3.8±0.9，左心房体积指数为49.1±15.2，在这些患者中进行了 RA-LAAE 手术。所有手术均顺利完成，手术时间为100±40分钟。术后住院时间平均为 1.7±1.3 天。在随访的第90天进行影像学检查后确认所有病例成功完成 LAAE。在90天内有1名患者（占3%）出现主要不良心血管事件(MACCE)，而在一年内没有其他患者发生此情况。

结论：对于口服抗凝药不耐受的患者，RA-LAAE 是一种安全且有效的治疗方法，并具有较低的主要不良心血管事件和死亡率。