Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Interv. 2014 Nov;7(11):1205-20. doi: 10.1016/j.jcin.2014.05.026. Epub 2014 Nov 17.
Percutaneous left atrial appendage closure technology for stroke prevention in patients with atrial fibrillation has significantly advanced in the past 2 decades. Several devices are under clinical investigation, and a few have already received Conformité Européene (CE)-mark approval and are available in many countries. The WATCHMAN device (Boston Scientific, Natick, Massachusetts) has the most supportive data and is under evaluation by the U.S. Food and Drug Administration for warfarin-eligible patients. The Amplatzer Cardiac Plug (St. Jude Medical, Plymouth, Minnesota) has a large real-world experience over the past 5 years, and a randomized trial comparing Amplatzer Cardiac Plug with the WATCHMAN device is anticipated in the near future. The Lariat procedure (SentreHEART Inc., Redwood City, California) has also gained interest lately, but early studies were concerning for high rates of serious pericardial effusion and major bleeding. The current real-world experience predominantly involves patients who are not long-term anticoagulation candidates or who are perceived to have high bleeding risks. This pattern of practice is expected to change when the U.S. Food and Drug Administration approves the WATCHMAN device for warfarin-eligible patients. This paper reviews in depth the procedural techniques, safety, and outcomes of the current leading devices.
在过去的 20 年中，经皮左心耳封堵技术在预防房颤患者卒中方面取得了显著进展。目前有几种装置正在临床研究中，其中一些已经获得了欧洲符合性 (CE) 标志的批准，并在许多国家得到应用。WATCHMAN 装置（波士顿科学公司，马萨诸塞州纳提克）拥有最多的支持数据，并正在接受美国食品和药物管理局对适合华法林治疗的患者的评估。Amplatzer 心脏封堵器（圣犹达医疗公司，明尼苏达州普利茅斯）在过去 5 年中有大量的实际应用经验，预计在不久的将来将进行一项比较 Amplatzer 心脏封堵器与 WATCHMAN 装置的随机试验。Lariat 手术（SentreHEART Inc.，加利福尼亚州雷德伍德城）最近也引起了关注，但早期的研究结果显示，心包积液和大出血的发生率较高。目前的实际应用经验主要涉及那些不适合长期抗凝治疗或被认为有高出血风险的患者。当美国食品和药物管理局批准 WATCHMAN 装置用于适合华法林治疗的患者时，这种治疗模式预计将会发生变化。本文深入综述了目前主要装置的手术技术、安全性和结果。
