Sakellaridis Timothy, Argiriou Mihalis, Charitos Christos, Tsakiridis Kosmas, Zarogoulidis Paul, Katsikogiannis Nikolaos, Kougioumtzi Ioanna, Machairiotis Nikolaos, Tsiouda Theodora, Arikas Stamatis, Mpakas Andreas, Beleveslis Thomas, Koletas Alexander, Zarogoulidis Konstantinos
1 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
J Thorac Dis. 2014 Mar;6 Suppl 1(Suppl 1):S70-7. doi: 10.3978/j.issn.2072-1439.2013.10.24.
Atrial fibrillation (AF) is consider to be the most common cardiac arrhythmia with an increasingly prevalence. It is postulated that the source of thromboembolism in 90% of patients with non-valvular AF arises from the left atrial appendage (LAA). Stroke is the most feared and life threatening consequence of thromboembolism. Oral anticoagulation (OAC) with vitamin-K-antagonists is the standard medical therapy for stroke prevention in patients with AF. Unfortunately, chronic therapy with vitamin-K-antagonists is contraindicated in 14% to 44% of patients with AF who are at risk for stroke, and its benefits are limited by underutilization, narrow therapeutic window and increased risk for bleeding, making it often undesired. Therefore, mechanical LAA exclusion is a means of preventing thrombus formation in the appendage and subsequent thromboembolic events in these patients. The LAA can be excluded from the systemic circulation via surgical, percutaneous, or thoracoscopic approaches. Several studies of percutaneous transcatheter delivery of dedicated LAA exclusion devices, such as the percutaneous left atrial appendage transcatheter occlusion (PLAATO) device, Watchman device and the Amplatzer cardiac plug, have shown encouraging results as an alternative to vitamin-K-antagonists therapy for selected patients, good feasibility and efficacy, with a high rate of successful implantation. We discuss the current evidence for LAA exclusion in patients and review their results.
心房颤动（AF）被认为是最常见的心律失常，且其患病率日益增加。据推测，90%非瓣膜性AF患者的血栓栓塞源来自左心耳（LAA）。中风是血栓栓塞最可怕且危及生命的后果。使用维生素K拮抗剂进行口服抗凝（OAC）是AF患者预防中风的标准药物治疗方法。不幸的是，在有中风风险的AF患者中，14%至44%的患者禁忌使用维生素K拮抗剂进行长期治疗，而且其疗效因使用不足、治疗窗狭窄和出血风险增加而受限，这使得它常常不被接受。因此，机械性左心耳封堵是预防这些患者心耳内血栓形成及随后血栓栓塞事件的一种方法。可通过外科手术、经皮或胸腔镜方法将左心耳与体循环隔离开。几项关于经皮导管输送专用左心耳封堵装置（如经皮左心耳导管封堵术（PLAATO）装置、Watchman装置和Amplatzer心脏封堵器）的研究显示，作为维生素K拮抗剂治疗的替代方法，对选定患者有令人鼓舞的结果，具有良好的可行性和疗效，植入成功率高。我们讨论了目前关于患者左心耳封堵的证据并回顾了其结果。
