Suwalski Grzegorz, Emery Robert, Gryszko Leszek, Kaczejko Kamil, Mroz Jakub, Skrobowski Andrzej
Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland.
Department of Cardiac Surgery, St. Joseph's Hospital, St. Paul, Minnesota.
Echocardiography. 2016 Sep;33(9):1368-73. doi: 10.1111/echo.13263. Epub 2016 May 10.
Epicardial left atrial appendage (LAA) closure with use of occluder is an emerging technique. Absence of remnant LAA stump is major criterion of successful obliteration. The aim of study was to assess early success rate of epicardial LAA closure.
Fifteen patients with persistent AF and coronary artery disease underwent off-pump coronary revascularization with concomitant ablation and LAA epicardial occlusion with use of two types of occluders. Before incision and after appendage closure, TEE was performed to assess the LAA anatomy, diameter of left atrial ridge, and remnant LAA stump after occlusion.
In 80% (12) of patients, formation of a left atrial diverticulum was observed with the left atrial ridge forming the superior boundary. In 5 patients (33%), a minimal remnant LAA stump was found, none exceeding 1 cm (average length: 1.5 ± 2.3 mm). In all patients, blood flow in LAA cavity distal to the occluder was absent. There was no significant difference in LAA type, average left atrial diameter, LAA orifice, LAA length, left atrial ridge, or size of occluder used between patients with and without a remnant LAA stump. Occurrence of a remnant LAA stump correlated significantly with unfavorable anatomy (LAA orifice < 20 mm and LA ridge > 5 mm; r = 0.5774, P = 0.02).
The early success of epicardial LAA occlusion is not dependent on LAA morphologic type or occluder used. A minimal remnant LAA stump not exceeding 1 cm in length without distal blood flow was observed in one-third of the cases.
使用封堵器进行心外膜左心耳（LAA）闭合是一项新兴技术。无残留LAA残端是成功闭塞的主要标准。本研究的目的是评估心外膜LAA闭合的早期成功率。
15例持续性房颤合并冠心病患者在非体外循环下行冠状动脉血运重建术，同时使用两种类型的封堵器进行消融和LAA心外膜封堵。在切开前和心耳闭合后，进行经食管超声心动图（TEE）检查，以评估LAA解剖结构、左心房嵴直径和封堵后残留的LAA残端。
80%（12例）的患者观察到左心房憩室形成，左心房嵴构成上边界。5例患者（33%）发现有最小的残留LAA残端，无一超过1 cm（平均长度：1.5±2.3 mm）。所有患者封堵器远端的LAA腔内均无血流。有残留LAA残端和无残留LAA残端的患者之间，在LAA类型、平均左心房直径、LAA开口、LAA长度、左心房嵴或使用的封堵器大小方面无显著差异。残留LAA残端的出现与不利的解剖结构显著相关（LAA开口<20 mm且左心房嵴>5 mm；r=0.5774，P=0.02）。
心外膜LAA封堵的早期成功不依赖于LAA形态类型或使用的封堵器。三分之一的病例中观察到有长度不超过1 cm且无远端血流的最小残留LAA残端。
