Betts Timothy R, Leo Milena, Panikker Sandeep, Kanagaratnam Prapa, Koa-Wing Michael, Davies David Wyn, Hildick-Smith David, Wynne Dylan G, Ormerod Oliver, Segal Oliver R, Chow Anthony W, Todd Derick, Cabrera Gomez Sandra, Kirkwood Graeme J, Fox David, Pepper Chris, Foran John, Wong Tom
Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
Royal Brompton & Harefield Hospital NHS Foundation Trust, London, United Kingdom.
Catheter Cardiovasc Interv. 2017 Feb 15;89(3):484-492. doi: 10.1002/ccd.26782. Epub 2016 Sep 21.
This study aimed at assessing the feasibility and long-term efficacy of left atrial appendage occlusion (LAAO) in a "real world" setting.
Although LAAO has recently emerged as an alternative to oral anticoagulants in patients with atrial fibrillation for the prevention of thromboembolic stroke, "real world" data about the procedure with different devices are lacking.
Eight centers in the United Kingdom contributed to a retrospective registry for LAAO procedures undertaken between July 2009 and November 2014.
A total of 371 patients (72.9 ± 8.3 years old, 88.9% males) were enrolled. The overall procedure success was 92.5%, with major events in 3.5% of cases. The device choice was Watchman in 63% of cases, Amplatzer Cardiac Plug in 34.7%, Lariat in 1.7%, and Coherex WaveCrest in 0.6%. A significant improvement in procedure success (from 89.2% to 95.7%; P = 0.018) and reduction of acute major complications (from 6.5% to 0.5%; P = 0.001) were observed between procedures in the first and the second half of the recruitment time. An annual 90.1% relative risk reduction (RRR) for ischemic stroke, an 87.2% thromboembolic events RRR, and a 92.9% major bleeding RRR were observed, if compared with the predicted annual risks based on CHADS2, CHA2DS2-Vasc, and HAS-BLED scores, respectively, over a follow-up period of 24.7 ± 16.07 months.
LAAO can be performed safely in a real world setting with good implant success rates and procedural outcomes. The long-term benefits of the procedure are reassuring in terms of both ischemic events and avoidance of severe bleeding associated with anticoagulation in this patient group. © 2016 Wiley Periodicals, Inc.
本研究旨在评估左心耳封堵术（LAAO）在“真实世界”环境中的可行性和长期疗效。
尽管LAAO最近已成为房颤患者预防血栓栓塞性卒中时口服抗凝药的替代方法，但缺乏关于不同器械该手术的“真实世界”数据。
英国的八个中心为2009年7月至2014年11月期间进行的LAAO手术的回顾性登记做出了贡献。
共纳入371例患者（年龄72.9±8.3岁，男性占88.9%）。总体手术成功率为92.5%，3.5%的病例发生了重大事件。63%的病例选择了Watchman装置，34.7%选择了Amplatzer心脏封堵器，1.7%选择了Lariat，0.6%选择了Coherex WaveCrest。在招募期的前半段和后半段手术之间，观察到手术成功率显著提高（从89.2%提高到95.7%；P = 0.018），急性重大并发症减少（从6.5%降至0.5%；P = 0.001）。在24.7±16.07个月的随访期内，与基于CHADS2、CHA2DS2-Vasc和HAS-BLED评分预测的年度风险相比，缺血性卒中的年度相对风险降低（RRR）为90.1%，血栓栓塞事件的RRR为87.2%，重大出血的RRR为92.9%。
LAAO在真实世界环境中能够安全进行，植入成功率和手术结果良好。就缺血事件以及避免该患者群体中与抗凝相关的严重出血而言，该手术的长期益处令人安心。© 2016威利期刊公司
