James R. Edgerton M.D.

Ramlawi, B., K. Bedeir and J. R. Edgerton (2019). “Totally Thoracoscopic Closure of the Left Atrial Appendage.” Ann Thorac Surg 107(1): e71-e73.

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The left atrial appendage (LAA) is a major site of clot formation in atrial fibrillation. Stand-alone thoracoscopic LAA complete closure can decrease stroke risk and may be an alternative to life-long oral anticoagulation. This report describes a technique for totally thoracoscopic LAA exclusion with an epicardial clip device. This approach provides a safe and likely more effective alternative to LAA management than other endocardial devices.

Curcio, N., L. Philpot, M. Bennett, J. Felius, M. B. Powers, J. Edgerton and A. M. Warren (2018). “Anxiety, depression, and healthcare utilization 1year after cardiac surgery.” Am J Surg Dec 11. [Epub ahead of print].

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BACKGROUND: While it is known that depression and anxiety influence cardiac surgery recovery, the mechanisms of such remain unclear. We examined the influence of anxiety and/or depression on health care utilization and quality of life (QOL) in the 12 months following cardiac surgery. METHODS: (N=306) patients at two North Texas hospitals were assessed pre-operatively, at 30 days, and one year post-operatively using the Hospital Anxiety and Depression Scale and Kansas City Cardiomyopathy Quality of Life measures. Patient healthcare utilization metrics included length of stay, outpatient visits, hospital stays, emergency department (ED) visits, and home healthcare. RESULTS: At 12 months post-surgery, anxious patients sustained more outpatient visits (p = 0.0129) than those without anxiety. Depressed patients differed significantly from non-depressed patients with significantly lower QOL (p<0.01), as well as more readmissions, ED visits, home healthcare use, and a longer length of stay (all p<0.05). CONCLUSIONS: Depressed patients utilized more expensive healthcare services and had lower QOL at 12 months follow up compared to non-depressed patients. Targeting depressed patients for intervention may foster a faster recovery and reduce excessive healthcare burden.

Yarlagadda, B., T. Deneke, M. Turagam, T. Dar, S. Paleti, V. Parikh, L. DiBiase, P. Halfbass, P. Santangeli, S. Mahapatra, J. Cheng, A. Russo, J. Edgerton, M. Mansour, J. Ruskin, S. Dukkipati, D. Wilber, V. Reddy, D. Packer, A. Natale and D. Lakkireddy (2018). “Temporal Relationships between Esophageal Injury Type and Progression in Patients Undergoing Atrial Fibrillation Catheter Ablation.” Heart Rhythm Sep 28. [Epub ahead of print].

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BACKGROUND: Currently very little is known about the onset, natural progression and management of esophageal injuries after atrial fibrillation (AF) ablation. OBJECTIVES: We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression and outcomes. METHODS: A comprehensive search of PubMed and Web of science was conducted until September 21st, 2017. All AF ablation patients who underwent upper gastro-intestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were reclassified into 3 types using our novel Kansas City Classification. (Type 1: Erythema; Type 2a: Superficial ulcers; Type 2b: Deep ulcers; Type 3a: perforation without communication with the atria; Type 3b: perforation with Atrio-esophageal fistula). RESULTS: Thirty studies met our inclusion criteria. Of the 4,473 patients, 3921 underwent upper GI evaluation. The overall incidence of esophageal injuries was 15%. There were 206 (36%) type 1, 222 (39%) type 2a and 142 (25 %) type 2b lesions. Six type 2b lesions (6/142, 4.2%) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1, type 2a and most type 2b lesions resolved with conservative management. One type 3a and one 3b lesions were fatal. CONCLUSION: Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (6/142, 4.2%) of type 2b lesions progressed to perforation and/or fistula formation and these patients need to be followed closely.

Ramlawi, B., K. Bedeir and J. R. Edgerton (2018). “Totally Thorascopic Closure of the Left Atrial Appendage.” Ann Thorac Surg Sep 18. [Epub ahead of print].

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The left atrial appendage (LAA) is a major site of clot formation in atrial fibrillation. Stand-alone thoracoscopic LAA complete closure can decrease stroke risk and may be an alternative to life-long oral anticoagulation.(1) We describe our technique for totally thoracoscopic LAA exclusion with an epicardial clip device. This approach provides a safe and likely more effective alternative to LAA management than other endocardial devices.

Turagam, M. K., P. Velagapudi, S. Kar, D. Holmes, V. Y. Reddy, M. M. Refaat, L. Di Biase, A. Al-Ahmed, M. K. Chung, T. Lewalter, J. Edgerton, J. Cox Nu, J. Fisher, A. Natale and D. R. Lakkireddy (2018). “Cardiovascular Therapies Targeting Left Atrial Appendage.” J Am Coll Cardiol Jun 25. [Epub ahead of print].

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Left atrial appendage (LAA) closure has evolved as an effective strategy for stroke prevention in patients with atrial fibrillation who are considered suitable for oral anticoagulation. There is strong evidence based on randomized clinical trials with 1 percutaneous device, as well as a large registry experience with several devices, regarding the safety and efficacy of this strategy. In addition, there is encouraging data regarding the effect of epicardial LAA closure on decreasing arrhythmia burden and improvements in systemic homeostasis by neurohormonal modulation. However, there are several unresolved issues regarding optimal patient selection, device selection, management of periprocedural complications including device-related thrombus, residual leaks, and pericarditis. In this review, we summarize the rationale, evidence, optimal patient selection, and common challenges encountered with mechanical LAA exclusion.