Thoracoscopic left atrial appendectomy.

In patients with non-rheumatic atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. However, there are patients who are not candidates for long-term oral anticoagulation, namely patients with high risk of bleeding complications or previous hemorrhagic stroke. In those patients, percutaneous closure of left auricular appendage (LAA) has demonstrated to be safe and efficacious preventing cardioembolic events. However, some LAA are too large or too fragile and they may not be suitable for occlusion. We report a case of a videothoracoscopic LAA excision performed in an 82-years-old male with a previous intracerebral hemorrhagic event, showing the need to suppress oral anticoagulant therapy, and a two lobes LAA configuration which precluded percutaneous tight occlusion. Thoracoscopic appendectomy is potentially safe and may permit surgeons to remove the LAA relatively simply and completely. We believe this procedure should be considered as a possible alternative option to percutaneous closure of LAA in patients who are at great risk of thromboembolism and in whom anticoagulation is no longer tolerable.