经导管卵圆孔未闭封堵术后残余房间隔分流的风险和结局：一项长期随访研究。
Risk and fate of residual interatrial shunting after transcatheter closure of patent foramen ovale: a long term follow up study.
机构信息
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany.
出版信息
Eur J Med Res. 2011 Jan 27;16(1):13-9. doi: 10.1186/2047-783x-16-1-13.
BACKGROUND
Percutaneous transcatheter closure of patent foramen ovale (PFO) in cryptogenic stroke is an alternative to medical therapy. There is still debate on different outcome for each currently available device. The impact of residual shunting after PFO-closure on recurrent arterial embolism is unknown. -
AIMS
(i) To evaluate the prevalence of residual interatrial shunting after device- closure of PFO, (ii) to identify risk factors predicting residual interatrial shunting after device implantation, and (iii) to investigate the outcome of patients after PFO-closure during long- term follow- up (FU).
METHODS AND RESULTS
Between 2000- 2005 PFO-closure was performed in 124 patients using four different devices: Amplatzer PFO-(n = 52), CardioSeal (n = 33), Helex (n = 23) and Premere (n = 16) occluder. All patients underwent serial contrast-enhanced transesophageal echocardiography (TEE) for 24 months after PFO- closure; clinical FU was at minimum 5 years up to 9.75 years (mean 6.67 ± 1.31 years). Overall-closure rate was 87% at 2 years, device-specific closure time curves differed significantly (p-logrank = 0.003). Independent risk factors for residual-shunting were implantation of a Helex occluder (hazard ratio [HR] 12.6, 95% confidence interval [CI] 2.6- 57.4, p = 0.002), PFO- canal- lengths (HR 1.2, 95%CI 1.1- 1.3, p = 0.004) and extend of atrial-septal-aneurysm (HR 1.1, 95%CI 0.9- 1.3; p = 0.05). 4 (3.2%) arterial embolic events occurred during a FU-period of 817.2 patient-years, actuarial annual thromboembolic-risk was 0.49%. All ischemic events were not related to residual PFO-shunting or device-related thrombus- formation.
CONCLUSION
Success rates of PFO- closure are mainly dependent on occluder-type, extend of concomitant atrial-septum-aneurysm and PFO-canal- length. Importantly, residual shunting after PFO-closure was not associated with recurrence of arterial embolism during long-term follow-up.
背景
卵圆孔未闭（PFO）介入封堵术治疗隐源性卒中是一种替代药物治疗的方法。目前，对于每种可用设备的不同结果仍存在争议。PFO 封堵后残余分流对复发性动脉栓塞的影响尚不清楚。
目的
（i）评估 PFO 封堵术后残余房间隔分流的发生率；（ii）确定预测 PFO 封堵术后残余房间隔分流的危险因素；（iii）探讨 PFO 封堵术后长期随访（FU）期间患者的结局。
方法与结果
2000 年至 2005 年间，使用四种不同的封堵器（Amplatzer PFO 封堵器[n = 52]、CardioSeal 封堵器[n = 33]、Helex 封堵器[n = 23]和 Premere 封堵器[n = 16]）对 124 例患者进行了 PFO 封堵术。所有患者均在 PFO 封堵术后 24 个月内行连续增强经食管超声心动图（TEE）检查；临床 FU 时间至少为 5 年，最长为 9.75 年（平均 6.67 ± 1.31 年）。2 年时总体封堵率为 87%，不同封堵器的封堵时间曲线差异有统计学意义（p-logrank = 0.003）。残余分流的独立危险因素包括植入 Helex 封堵器（风险比[HR]12.6，95%置信区间[CI]2.6-57.4，p = 0.002）、PFO 管腔长度（HR 1.2，95%CI 1.1-1.3，p = 0.004）和房间隔-卵圆孔-膨出（ASA）程度（HR 1.1，95%CI 0.9-1.3，p = 0.05）。在 817.2 患者年的 FU 期间发生了 4 例（3.2%）动脉栓塞事件，累积年血栓栓塞风险为 0.49%。所有缺血性事件均与残余 PFO 分流或器械相关血栓形成无关。
结论
PFO 封堵术的成功率主要取决于封堵器类型、ASA 程度和 PFO 管腔长度。重要的是，PFO 封堵术后残余分流与长期随访期间复发性动脉栓塞无关。
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