Initial Experience with Standalone Thoracoscopic Left Atrial Appendage Occlusion Using AtriClip Pro2: A Single-Center Retrospective Cohort Study in Latvia

Background and Objectives: Left atrial appendage (LAA) closure is an established strategy for stroke prevention in selected patients with atrial fibrillation (AF), particularly when long-term oral anticoagulation (OAC) is contraindicated. Thoracoscopic epicardial LAA occlusion using the AtriClip Pro2 device provides a minimally invasive surgical approach; however, evidence for standalone use remains limited. This study aimed to describe the initial feasibility and early clinical outcomes of standalone thoracoscopic LAA occlusion using AtriClip Pro2 in Latvia. Materials and Methods: We performed a single-center retrospective observational study including all consecutive patients who underwent standalone thoracoscopic LAA occlusion at the Department of Cardiac Surgery, Pauls Stradins Clinical University Hospital, between December 2024 and March 2026. Baseline characteristics, procedural outcomes, perioperative complications, rehospitalizations, and antithrombotic therapy status were assessed. LAA closure was assessed by transesophageal echocardiography (TEE). Results: Fourteen patients were included. Mean age was 63.6 ± 16.7 years (median 67.0; IQR 54.8–76.8), and 64.3% were female. Thoracoscopic completion was achieved in 13/14 patients (92.9%; 95% CI 68.5–98.7%); one patient (7.1%) required conversion to median sternotomy because of intraoperative bleeding. Complete LAA exclusion without residual flow or stump was documented in all 14 patients (100%; 95% CI 78.5–100%). No perioperative stroke or mortality occurred. At three months, follow-up data were available for all patients, and antithrombotic therapy had been discontinued in 12/14 patients (85.7%). Conclusions: This small, heterogeneous, single-center series supports the technical feasibility of standalone thoracoscopic AtriClip Pro2 implantation in selected patients. These encouraging early findings warrant further evaluation in larger cohorts with longer clinical follow-up and standardized postoperative imaging.