85岁及以上心房颤动患者左心耳Watchman封堵疗效分析  

Efficacy of Watchman occlusion of the left atrial appendage in patients≥85 years with atrial fibrillation

作　　者：赵志宏 王赛华 宋湘 罗俊 武英彪 朱茜 方明 郇强 张小刚 田蓓 顾薇 赫舒文 宁忠平[1] Zhao Zhihong;Wang Saihua;Song Xiang;Luo Jun;Wu Yingbiao;Zhu Qian;Fang Ming;Huan Qiang;Zhang Xiaogang;Tian Bei;Gu Wei;He Shuwen;Ning Zhongping(Department of Cardiology,Shanghai Pudong New Area Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院心内科,201318

出　　处：《中华老年医学杂志》2022年第1期11-14,共4页Chinese Journal of Geriatrics

基　　金：上海市医学重点专科建设计划项目(ZK2019B25);浦东新区卫健委高原学科建设基金(PWYgy2018-03);浦东新区卫计委重点专科建设基金(PWZzk2017-01)。

摘　　要：目的评价85岁及以上心房颤动(房颤)患者采用Watchman左心耳封堵的安全性和有效性。方法回顾性分析2016年8月至2020年12月在上海健康医学院附属周浦医院行Watchman左心耳封堵老年房颤患者515例,其中85岁及以上(85~91岁)患者73例,完成经食道超声心动图复查的44例(60.3%)为高龄组,同期60~65岁53例为对照组,比较两组患者基线资料、术中参数、抗栓治疗方案及1年随访预后的差异。结果高龄组患者房颤类型、缺血性脑卒中和(或)短暂性脑缺血发作病史与对照组比较差异无统计学意义(均P>0.05),冠心病、肾功能不全发病率更高,心力衰竭情况更严重。高龄组较对照组患者CHA2DS2-VASC和HAS-BLED评分增加,(6.0±1.5)分比(3.6±1.5)分和(3.2±1.2)分比(2.3±1.3)分(t值分别为7.682和3.871,均P<0.05);一站式手术率低,13.6%(6例)比50.9%(27例),差异有统计学意义(χ^(2)=10.517,P<0.05);左心耳封堵术中Watchman封堵器大小、更换封堵器和封堵器压缩比、残余分流两组比较差异无统计学意义(均P<0.05)。高龄组与对照组封堵器械相关血栓发生率4.5%(2/44)比3.8%(2/53),差异无统计学意义(P>0.05);12个月随访期间无新发缺血性脑卒中,短暂性脑缺血发作及脑出血,3例死于心力衰竭,1死于恶性肿瘤。结论85岁以上高龄房颤患者用Watchman行左心耳封堵安全可行,预防缺血性脑卒中和(或)短暂性脑缺血发作安全及有效,但需慎重评估心肾功能及身体状况以决定是否行左心耳封堵。Objective To analyze the safety and efficacy of left atrial appendage closure(LAAC)with Watchman in patients≥85 years with atrial fibrillation(AF).Methods 515 elderly patients with atrial fibrillation,including 73 patients aged 85 years or older(85~91),who had undergone Watchman LAAC at Zhoupu Hospital affiliated to Shanghai Health Medical College from August 2016 to December 2020,were retrospectively analyzed.Of those≥85 years,44(60.3%)with transesophageal echocardiography records were assigned to the elderly group.Fifty-three patients aged 60 to 65 were selected as the control group.Differences in baseline data,intraoperative conditions,antithrombotic treatment plans and 1-year follow-up prognosis were compared between the two groups.Results Compared with the control group,there was no difference in AF types,history of ischemic stroke/transient ischaemic attack(all P>0.05),but there were higher incidences of coronary heart disease and renal insufficiency,more severe heart failure,higher CHA2DS2-VASC(6.0±1.5 vs.3.6±1.5),HAS-BLED(3.2±1.2 vs.2.3±1.3)scores(t values were 7.682 and 3.871,respectively,P<0.05),and a lower one-stop surgery rate(6 cases or 13.6%vs.27 cases or 50.9%,χ^(2)=10.517,P<0.05)in the advanced age group.There was no difference in the diameter of the Watchman device,rate of device replacement,compression percentage and residual flow between the two groups during the perioperative period.The incidences of device-related thrombosis were 4.5%(2/44)and 3.8%(2/53)for the advanced age group and the control group,respectively,but the difference was not statistically significant(P>0.05).During the 12-month follow-up,there were no cases of ischemic stroke or intracerebral hemorrhage.Three died of heart failure and 1 died of cancer.Conclusions LAAC with Watchman is safe and effective for patients over 85 years with AF,but the decision on the procedure should be based on careful assessment of patients'cardiac and renal function and general health.

关 键 词：心房颤动 左心耳封堵 疗效比较研究 

分 类 号：R541.75[医药卫生—心血管疾病]