News | 22 June 2020

New technique used to treat blood clot in the heart

Laparoscopy on beating heart offers a number of benefits

For the first time in Europe, surgeons at Maastricht UMC+ have used a new technique to treat a blood clot in the heart of a patient with atrial fibrillation. Using laparoscopy on the still beating heart, doctors were able to isolate the clot and enclose it in what is called the atrial appendage. With this procedure, the patient is spared a lengthy operation in which the heart has to be stopped. Although this category of patient is not encountered very often, the Maastricht heart specialists see it as a valuable procedure.

Patients with atrial fibrillation have an increased risk of suffering a stroke (also called CVA). This risk arises when a blood clot forms in the left atrium of the heart. If such a clot breaks free, it can reach the brain, causing a stroke. For this reason, these patients are often prescribed anti-coagulant medicines. However, there is a category of patients in whom this medication can cause life-threatening bleeding. In such cases, a blood clot will have to be surgically removed.

Atrial appendage
In order to remove a blood clot in the heart (or to be precise, in the left atrial appendage – a tubular sac attached to the left atrium), the heart needs to be stopped. The patient is then connected to the heart-lung machine. The left atrial appendage is opened and the clot removed. This is a serious and complex operation which carries a risk of complications and is followed by a long period of recovery. To prevent this, the Maastricht team performed a laparoscopy in which a clip is pushed over the base of the atrial appendage. In this way, the heart can continue to beat and the clot can be isolated and enclosed, so that it poses no further risk.

Less invasive
The laparoscopy is a much less invasive method than open-heart surgery. The operation is many times shorter, lasting some 15 minutes as opposed to a couple of hours, there is less risk of bleeding and the recovery time is shorter. "Patients for whom this procedure is suitable only come up once every year or two," says heart surgeon Bart Maesen, who performed the operation with colleagues from Heart+Vascular Center. "Of course, we want to offer every patient the best possible treatment. That is why we are always looking for new, innovative techniques and methods, so that we can help patients while ensuring that they have the fewest complications possible. This is our responsibility in our role as teaching hospital."

The Maastricht heart specialists describe the procedure in the scientific journal IJC Heart & Vasculature.