经胸心脏超声心动图与经食管超声心动图用于使用Watchman封堵器进行左心耳封堵术的比较
Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman.
作者信息
Frangieh Antonio H, Alibegovic Jasmina, Templin Christian, Gaemperli Oliver, Obeid Slayman, Manka Robert, Holy Erik W, Maier Willibald, Lüscher Thomas F, Binder Ronald K
机构信息
Department of Cardiology, University Heart Center, University Hospital, Zürich, Switzerland.
出版信息
Catheter Cardiovasc Interv. 2017 Aug 1;90(2):331-338. doi: 10.1002/ccd.26805. Epub 2016 Sep 21.
BACKGROUND
Left atrial appendage occlusion (LAAO) is mostly performed by transesophageal echocardiography (TEE) guidance. Intracardiac echocardiography (ICE) may be an alternative imaging modality for LAAO that precludes the need for general anesthesia or sedation.
METHODS AND RESULTS
All consecutive single center, single operator LAAO candidates were analyzed. Baseline clinical and procedural characteristics and in-hospital outcomes were compared between patients in whom a Watchman was implanted with ICE vs. TEE guidance. In 76 consecutive patients the Watchman device was deployed under ICE in 32 patients (42%) and under TEE guidance in 44 patients (58%). Baseline characteristics were comparable between groups, except that patients in the TEE group were older (81 [75-85] years vs. 75 [68-80] years, P = 0.007). Total injected contrast media as well as fluoroscopy time were comparable between groups (90 ml [54-140] vs. 85 ml [80-110], P = 0.86 and 7.9 min [6.4-15.5] vs. 9.8 min [7.0-13.2], P = 0.51, for TEE vs. ICE, respectively). However, time from femoral venous puncture to transseptal puncture and to closure was longer in the ICE group (14 min [7.3-20] vs. 6 min [3.3-11], P = 0.007 and 48 min [40-60] vs. 34.5 min [27-44], P = 0.003, respectively). In the TEE group one patient suffered esophageal erosion with bleeding, which was managed conservatively and one non-LAAO related in-hospital mortality occurred in an 88-year-old patient. Device implantation success rate was 100% in both groups. No device embolization, no significant peri-device leak, no tamponade, no stroke, and no access site bleeding occurred in any patient. Total hospital stay for stand-alone LAAO was comparable between groups (2 days [2-2] vs. 2 days [2-3.3], P = 0.17, in ICE vs. TEE, respectively).
CONCLUSIONS
ICE guidance for LAAO with the Watchman device is feasible and comparable to TEE and may become the preferred imaging modality for LAAO. © 2016 Wiley Periodicals, Inc.
背景
左心耳封堵术（LAAO）大多在经食管超声心动图（TEE）引导下进行。心腔内超声心动图（ICE）可能是LAAO的另一种成像方式，无需全身麻醉或镇静。
方法与结果
对所有连续的单中心、单操作者LAAO候选患者进行分析。比较在ICE引导与TEE引导下植入Watchman的患者的基线临床和手术特征以及住院结局。在76例连续患者中，32例患者（42%）在ICE引导下植入Watchman装置，44例患者（58%）在TEE引导下植入。除TEE组患者年龄较大外（81[75 - 85]岁 vs. 75[68 - 80]岁，P = 0.007），两组基线特征具有可比性。两组间总注射造影剂及透视时间具有可比性（TEE组与ICE组分别为90 ml[54 - 140] vs. 85 ml[80 - 110]，P = 0.86；7.9 min[6.4 - 15.5] vs. 9.8 min[7.0 - 13.2]，P = 0.51）。然而，ICE组从股静脉穿刺到房间隔穿刺及封堵的时间更长（分别为14 min[7.3 - 20] vs. 6 min[3.3 - 11]，P = 0.007；48 min[40 - 60] vs. 34.5 min[27 - 44]，P = 0.003）。在TEE组，1例患者发生食管糜烂伴出血，经保守治疗；1例88岁患者发生与LAAO无关的住院死亡。两组装置植入成功率均为100%。所有患者均未发生装置栓塞、明显的装置周围渗漏、心包填塞、卒中及穿刺部位出血。单纯LAAO的总住院时间两组具有可比性（ICE组与TEE组分别为2天[2 - 2] vs. 2天[2 - 3.3]，P = 0.17）。
结论
使用Watchman装置进行LAAO时，ICE引导是可行的，与TEE相当，可能成为LAAO的首选成像方式。©2016威利期刊公司
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