左心耳封堵术围手术期有效性和安全性的单中心回顾性研究  

Periprocedural efficacy and safety of left atrial appendage closure:a single-centre retrospective study

作　　者：李双[1] 刘建云 贾鹏 任重远 李翔 闫美玉 王依倩[1,3] 张敬莹[1] 裴艳 郭荣 李海玲[1] 吴彦[5] 林逸贤[6] 唐恺[1] 朱梦云[1] 赵冬冬[1] 陈维[1] 徐亚伟[1] Li Shuang;Liu Jianyun;Jia Peng;Ren Zhongyuan;Li Xiang;Yan Meiyu;Wang Yiqian;Zhang Jingying;Pei Yan;Guo Rong;Li Hailing;Wu Yan;Lin Yixian;Tang Kai;Zhu Mengyun;Zhao Dongdong;Chen Wei;Xu Yawei(Department of Cardiology,Shanghai Tenth People’sHospital,Shanghai 200072,China;Departm ent of Cardiology,Nantong Sixth People’s Hospital,Nantong 226000,China;Department of Nursing,Shanghai Tenth People’s Hospital,Shanghai 200072,China;Department of Cardiology,Putuo People’s Hospital,Shanghai 200072,China;Department of Cardiology,Wuhu First People’s Hospital,Anhui 241000,China;Department of Cardiology,Prince of Wales Private Hospital,The Chinese University of Hong Kong,Hongkong 999077,China)

机构地区：[1]上海市第十人民医院心内科,200072 [2]江苏省南通市第六人民医院心内科,226000 [3]上海市第十人民医院护理部,200072 [4]上海市普陀区人民医院心内科,200060 [5]安徽省芜湖市第一人民医院心内科,241000 [6]香港中文大学附属威尔斯亲王医院心内科,中国香港999077

出　　处：《中华心血管病杂志（网络版）》2019年第1期102-122,共21页Chinese Video Journal of Cardiology

基　　金：科技部国家重点研发计划数字诊疗装备研发重点专项(2017YFC0111800);国家自然科学基金(81800441);上海市科学技术委员会科研计划项目(16411965700)。

摘　　要：目的回顾性分析左心耳封堵术(left atrial appendage closure,LAAC)的有效性及围手术期安全性。病例介绍连续性纳入上海市第十人民医院2014年4月至2019年3月31日接受LAAC的心房颤动(以下简称房颤)患者,共计550例。年龄(70.2±8.7)岁、范围38~89岁,其中男性315例(57.3%),女性235例(42.7%);阵发性房颤181例(32.9%),持续或永久性房颤369例(67.1%)。干预措施共计使用2大类6种封堵器:(1)"塞式"封堵器(plug-like occluder,PLO),包括Watchman封堵器、Lefort封堵器;(2)"盘式"封堵器(disc-like occluder,DLO),包括LAmbre封堵器、Leftear封堵器、Lacbes封堵器和Amplatzer Cardiac Plug(ACP)封堵器。文献检索及分析评估植入成功率和围手术期严重不良事件(serious adverse event,SAE)。植入成功标准是术后即刻经食管超声心动图(transesophageal echocardiography,TEE)评价封堵器残余分流(peri-device leak,PDL),须满足PLO的PDL≤5 mm或DLO的PDL≤3 mm。SAE包括死亡、卒中、严重心包积液、封堵器相关或手术相关并发症。结果550例植入封堵器的患者中,PLO 328例(其中Watchman封堵器247例、Lefort封堵器81例)、DLO封堵器222例(其中LAmbre封堵器131例、Leftear封堵器48例、Lacbes封堵器40例、ACP封堵器3例)。CHA2DS2-VASc评分(4.5±1.8)分。封堵成功547例(99.6%),完全封堵499例(90.7%),PDL≤3 mm有546例(99.3%)。DLO和PLO两组在完全封堵率和PDL≤3 mm比例上差异无统计学意义(x2=0.6002、1.0798,P均>0.05)。与PLO相比,DLO组更换封堵器比例更高[47例(21.2%)vs.22例(6.7%),χ^(2)=25.2443,P<0.01]。9例行PLO封堵失败,行补救性DLO植入,8例封堵成功。围手术期共计16例(2.9%)发生18例次SAE,其中死亡1例、卒中1例、心室颤动1例、封堵器脱落(LAmbre封堵器)1例、严重心包积液7例(行外科修补1例)、假性动脉瘤或动静脉瘘4例(行外科修补1例)、出现封堵器压迫冠状动脉3例(均为PLO封堵器)。结论应用多种封堵器行左心耳封堵术,总Objective To analyze retrospectively the periprocedural efficacy and safety of percutaneous left atrial appendage closure(LAAC).Subjects Between April 2014 and March 2019,550[315 males(57.3%)and 235 females(42.7%),aged 70.2±8.7(from 38 to 89)years]patients with non-valvular atrial fibrillation(paroxysmal,n=181,32.9%;persistent or long-standing persistent,n=369,67.1%)were enrolled consecutively for LAAC in Shanghai Tenth People’s Hospital.Interventions LAAC was performed using two-size and 6-brand occluders[plug-like occluder(PLO)including Watchman,and Lefort;disc-like occluder(DLO)including LAmbre,Leftear,Lacbes,and Amplatzer Cardiac Plug(ACP)].Main Outcomes and Measurements The main outcomes were rates of implant success and peri-procedural complications.Implant success was defined as the immediate peri-device leak(PDL)≤5 mm for PLO or 3 mm for DLO,determined by transesophageal echocardiography(TEE),respectively.Serious adverse events(SAE)included death,stroke,serious pericardial effusion,and other associated serious complications.Results A total of 550 patients were enrolled in this study,including 328 patients with PLOs(257 with Watchman,and 81 with Lefort)and 222 with DLOs(131 with LAmbre,48 with Leftear,40 with Lacbes,and 3 with ACPs).The CHA2DS2-VASc score was 4.5±1.8.The device was successfully deployed in 99.6%(547 in 550)of patients with no flow achieved in 90.7%and minimal residual flow(PDL≤3 mm)achieved in 99.3%of implanted patients.Compared with the procedure with DLO,LAAC with PLO has a higher rate of the concomitant catheter ablation[232(70.7%)vs.68(30.6%),χ^(2)=85.8,P<0.05].Compared with the procedure using DLO,LAAC using PLO has a lower rate of device replacement[47 subjects(21.2%)vs.22 subjects(6.7%),χ^(2)=25.2443,P<0.01].Nine procedures which failed with PLO initially,were successfully done using DLOs remedially with an implant success rate of 88.9%(8 in 9).Eighteen periprocedural SAEs occurred in sixteen patients(2.9%)including death,stroke,ventricular fibrillation,and device misplace

关 键 词：心耳 左心耳封堵 封堵器 手术中并发症 治疗结果 

分 类 号：R54[医药卫生—心血管疾病]