The Effects of Stand-alone Thoracoscopic Left Atrial Appendage Clipping on Blood Pressure and Electrolytes

Abstract Background: The natriuretic peptides secreted from the left atrial appendage could affect patients' system homeostasis by antagonizing the renin-angiotensin-aldosterone system. Thus, the epicardial LAA closure may induce unwanted hyponatremia and hypotension cause of isolating the LAA from the circulation. In this study, we aim to explore this phenomenon following stand-alone thoracoscopic LAA clipping and provide a hypothesis of the potential mechanism.Methods: This was a retrospective, observational study including 27 stroke patients with AF who underwent thoracoscopic LAA clipping. Electrolyte, BP, heart rate, and BNP were measured before the procedure, immediately after the device release, at 1st day, 2nd day postoperation, and 24h before discharge. Fluid amounts were only monitored postoperatively.Results: There was a significantly acute reduction in serum sodium (mmol/L) at all the timepoints postoperation when compared to baseline. The blood pressure has no significant difference when compared with baseline levels at discharge.Conclusion: Epicardial LAA clipping induce an acute decrease in serum sodium and MAP postoperation which indicates to the surgeons that the postoperative intake fluid amounts and serum sodium level management should be appropriate. Although the fluctuation of blood pressure of patients was observed perioperative, it has returned to the baseline level till discharge and the accurate and further mechanisms still need more study.