心腔内超声心动图和经食管超声心动图指导经皮左心耳封堵术围术期及术后2年随访结果比较  

Comparison of the results of percutaneous left atrial appendage closure guided by intracardiac and transesophageal echocardiography during perioperative period and after 2-year follow-up

作　　者：高昉 卓伟东 王彬浩 傅国华 郁一波[1] 杜先锋 丰明俊[1] 刘晶[1] 储慧民[1] Gao Fang;Zhuo Weidong;Wang Binhao;Fu Guohua;Yu Yibo;Du Xianfeng;Feng Mingjun;Liu Jing;Chu Huimin(Arrhythmia Center,The First Affiliated Hospital of Ningbo University,Ningbo 315010,China)

机构地区：[1]宁波大学附属第一医院心律失常诊疗中心,宁波315010

出　　处：《中华心律失常学杂志》2023年第5期390-396,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：浙江省医药卫生计划项目(2020KY821,2021KY980)。

摘　　要：目的对比心腔内超声心动图(ICE)和经食管超声心动图(TEE)指导下经皮左心耳封堵术(LAAC)围术期及术后2年随访的安全性及有效性。方法本文为回顾性研究。连续入选2018年1月至2021年6月在宁波大学附属第一医院心律失常诊疗中心行左心耳封堵术的非瓣膜性心房颤动(房颤)患者,其中不能耐受或不愿意接受术中TEE的患者,用ICE代替TEE。对比TEE组与ICE组患者的手术成功率、围术期不良事件及随访结局。结果共入选接受ICE指导下LAAC的非瓣膜性房颤患者109例(ICE组),年龄74(67,80)岁,其中女42例(38.5%,42/109)。应用倾向评分1∶3匹配同时期接受TEE指导下LAAC患者327例(TEE组),年龄72(68,76)岁,其中女131例(40.1%,131/327)。所有患者均成功植入左心耳封堵器。术中X线曝光量[(136.8±134.4)mGy对(204.7±252.9)mGy,P=0.008]、X线曝光时间[(6.4±4.3)min对(7.5±4.6)min,P=0.027]及造影剂剂量[(28.0±31.0)ml对(75.2±29.8)ml,P<0.001]ICE组明显低于TEE组。此外,ICE组住院时间明显短于TEE组[(3.9±0.9)d对(4.9±0.9)d,P<0.001]。两组患者在围术期均无血栓栓塞及死亡事件发生,两组出血事件发生率差异无统计学意义(P>0.05)。在术后45 d随访及2年随访期,两组残余分流、封堵器表面血栓、血栓栓塞事件及出血事件比例相当,差异无统计学意义(P>0.05)。结论ICE可显著减少X线曝光量、X线曝光时间、造影剂剂量及住院时间,且不增加围术期并发症。ICE及TEE指导经皮LAAC术后长期随访安全性和有效性相当。ObjectiveTo investigate the safety and efficacy of percutaneous left atrial appendage closure(LAAC)guided by intracardiac echocardiography(ICE)and transesophageal echocardiography(TEE)periprocedurally and after 2-year follow-up.MethodsThis study was a retrospective study.Patients with nonvalvular atrial fibrillation(NVAF)who underwent LAAC from January 2018 to June 2021 in Arrhythmia Center,The First Affiliated Hospital of Ningbo University were continuously enrolled.ICE was used to replace TEE to guide LAAC if patients could not tolerate or refusal to intraoperative TEE guidance.The implantation success rate,periprocedural adverse events and follow-up outcome were compared between the two groups.ResultsA total of 109 patients who received ICE-guided LAAC were included(ICE group).The median age was 74(67,80)years,including 42(38.5%,42/109)females.Propensity score match(1∶3)was performed to select patients who underwent TEE-guided LAAC during the same period(TEE group).The median age of TEE group was 72(68,76)years,including 131(40.1%,131/327)females.In ICE group,X-ray exposure dose[(136.8±134.4)mGy vs.(204.7±252.9)mGy,P=0.008],X-ray exposure time[(6.4±4.3)min vs.(7.5±4.6)min,P=0.027]and contrast dose[(28.0±31.0)ml vs.(75.2±29.8)ml,P<0.001]were significantly lower than those in TEE group.The hospital stay was also shorter in ICE group[(3.9±0.9)d vs.(4.9±0.9)d,P<0.001].There was no death in both groups periprocedurally.No statistical significance was observed for thromboembolic events and bleeding events between ICE group and TEE group.The rates of peridevice leakage,device-related thrombus,thromboembolic events and bleeding events were similar between the two groups at 45-day and 2-year follow-up after LAAC.ConclusionICE can significantly reduce the X-ray exposure dose,X-ray exposure time,contrast dose and hospital stay duration.Long-term safety and efficacy after LAAC are comparable between ICE group and TEE group.

关 键 词：心房颤动 左心耳封堵术 经食管超声心动图 心腔内超声心动图 

分 类 号：R654.2[医药卫生—外科学]