Pillai Anand M, Kanmanthareddy Arun, Earnest Matthew, Reddy Madhu, Ferrell Ryan, Nath Jayanth, Pillarisetti Jayasree, Vallakati Ajay, Lakkireddy Dhanunjaya
Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas.
Heart Rhythm. 2014 Nov;11(11):1877-83. doi: 10.1016/j.hrthm.2014.06.035. Epub 2014 Jun 30.
Left atrial appendage (LAA) ligation with the Lariat device is a therapeutic option to prevent thromboembolic stoke in patients with nonvalvular atrial fibrillation (AF) at high risk for systemic thromboembolization and bleeding related to use of anticoagulation. In rare cases, this procedure could leave the LAA incompletely ligated with continued risk of stroke.
The purpose of this study was to investigate the incidence and characteristics of LAA leak following ligation using the Lariat device and the feasibility of leak closure with the Amplatzer septal occluder device or a repeat Lariat application.
Seventy-one consecutive patients who underwent LAA ligation by the Lariat device were followed-up with transesophageal echocardiography to evaluate for the presence of appendage leaks, characterization of the leaks, and the presence of any thrombus. Patients with LAA leaks underwent definite closure of the leak.
Six patients had LAA leaks with a mean leak size of 4.3 ± 0.6 mm. All leaks were concentric in nature. None of the patients had LAA thrombus. Leaks in 5 of these patients were successfully closed using an Amplatzer septal occluder device (St. Jude Medical); the leak in the sixth patient was closed using a repeat Lariat procedure.
LAA leaks from incomplete ligation of the LAA following the Lariat procedure are not uncommon and could be successfully closed with an Amplatzer septal occluder device or a repeat Lariat procedure.
使用Lariat装置结扎左心耳（LAA）是预防非瓣膜性心房颤动（AF）患者发生血栓栓塞性卒中的一种治疗选择，这些患者存在全身性血栓栓塞及与抗凝治疗相关出血的高风险。在罕见情况下，该手术可能导致LAA结扎不完全，仍有卒中风险。
本研究旨在调查使用Lariat装置结扎后LAA渗漏的发生率和特征，以及使用Amplatzer房间隔封堵器装置封闭渗漏或再次应用Lariat装置的可行性。
对71例连续接受Lariat装置LAA结扎术的患者进行经食管超声心动图随访，以评估有无心耳渗漏、渗漏特征及有无血栓形成。存在LAA渗漏的患者接受了渗漏的确定性封闭治疗。
6例患者存在LAA渗漏，平均渗漏大小为4.3±0.6mm。所有渗漏本质上均为同心性。所有患者均无LAA血栓形成。其中5例患者的渗漏使用Amplatzer房间隔封堵器装置（圣犹达医疗公司）成功封闭；第6例患者的渗漏通过再次应用Lariat手术封闭。
Lariat手术后因LAA结扎不完全导致的LAA渗漏并不少见，可使用Amplatzer房间隔封堵器装置或再次应用Lariat手术成功封闭。
