接受其他心脏介入手术治疗的心房纤颤患者左心耳封堵术应用观察  

Feasibility and safety of left atrial appendage closure in atrial fibrillation patients undergoing other intervention therapy

作　　者：王宇彬 吴永健 宋光远 楚建民 王靖 张海彤 WANG Yubin;WU Yongjian;SONG Guangyuan;CHU Jianmin;WANG Jing;ZHANG Haitong(Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院,北京100037

出　　处：《山东医药》2018年第35期28-32,共5页Shandong Medical Journal

基　　金：中国博士后科学基金资助项目(2018M630111)

摘　　要：目的探讨左心耳封堵术(LAAC)用于接受其他心脏介入手术治疗的心房纤颤(房颤)患者的安全性及可行性。方法房颤患者12例(年龄60~84岁,CHA2DS2-VASc评分2~8分,HAS-BLED评分1~4分),其中2例接受过经导管主动脉瓣置换术(TAVR)、5例接受过经皮冠状动脉介入治疗(PCI)、5例需要接受房颤射频消融术(RFCA)治疗,均不适合单纯服用抗凝药物预防栓塞事件。2例TAVR术后的房颤患者,分别于TAVR术后3、6个月接受LAAC治疗;5例PCI后的房颤患者,PCI后3.8~6.2个月接受LAAC治疗;5例需要接受RFCA治疗的房颤患者,RFCA治疗同时接受LAAC治疗。结果 12例患者LAAC均成功,左心耳最大直径18~29 mm,所用封堵器直径27~33 mm,封堵器释放后压缩比为16.7%~33.0%;封堵器释放后1例存在3 mm封堵器周围残余分流,其余患者均无残余分流。LAAC术后随访45~122 d,随访期间12例患者均无动脉栓塞、无任何出血发生。结论对于TAVR、PCI术后及需要行RFCA治疗的房颤患者,因其不适合服用抗凝药物预防栓塞事件,给予LAAC治疗及RFCA+LAAC"一站式"治疗是安全、可行的。Objective To evaluate the safety and feasibility of left atrial appendage closure(LAAC)in atrial fibrillation(Af)patients undergoing other intervention therapy.Methods Twelve patients with Af(age:60-84,CHA2DS2-VASc:2-8,and HAS-BLED:1-4)were retrospectively analyzed,during whom,2 cases underwent transcatheter aortic valve replacement(TAVR),5 cases underwent percutaneous coronary intervention(PCI),and 5 cases needed the radiofrequency ablation(RFCA);all these patients were not suitable for taking anticoagulant drugs alone to prevent embolic events.Two patients with Af after TAVR were treated with LAAC after TAVR(3 months,6 months);five patients with Af after PCI received LAAC after PCI(3.8 to 6.2 months);five patients with Af requiring RFCA treatment underwent RFCA and LAAC at the same time.Results Twelve patients undergoing LAAC were successful.The maximum diameter of the left atrial appendage was 18 to 29 mm,the diameter of the occluder used was 27 to 33 mm,and the compression ratio after releasing the occluder was 16.7%-33.0%.One patient had a residual shunt around 3 mm of occluder after releasing the occluder,and the remaining patients had no residual shunt.After LAAC,all patients were followed up for 45-122 days.During the follow-up period,12 patients had no arterial embolism and no bleeding.Conclusion As for patients with Af after TAVR,PCI,or who requires RFCA therapy,it is safe and feasible to give LAAC treatment and RFCA+LAAC“one-stop”treatment because they are not suitable for taking anticoagulant drugs to prevent embolic events.

关 键 词：左心耳封堵术 心房纤颤 血栓栓塞 心源性脑卒中 脑栓塞 抗凝治疗 冠状动脉内支架置入术 经导管主动脉瓣置换术 射频消融术 

分 类 号：R541.7[医药卫生—心血管疾病]