Mokráček Aleš, Kurfirst Vojtěch, Bulava Alan, Haniš Jiří
Vnitr Lek. 2017 Winter;63(1):31-35.
Atrial fibrillation (AFib) is related to a high risk of stroke. The main role in etiopathogenesis is played by the left atrial appendage (LAA). As many as 95 % of thrombi in nonvalvular atrial fibrillation are located in the appendage. Prevention of stroke then consists in permanent anticoagulation which, however, has its limits and risks. An alternative method is the left atrial appendage occlusion. In our report, we would like to present a new possibility of the closure using the epicardial system AtriClip (AtriCure).
In the period beginning in July 2012 - September 2015 we performed LAA closure in 101 patients. A mean age of 65 ± 6 years, 47 women, CHA2DS2 VASc (Ø) 2.47 (0-6). Monitoring 1 837 (Ø 18.5) months. A concomitant procedure was performed in 37 patients, endoscopic MAZE plus clip in 57 patients, and 7 patients underwent stand-alone implantation of the clip. The clip was implanted from full sternotomy, minitoracotomy or through thoracoscopy. Clip loading, residual recess and endoleak were assessed through endoscopic ultrasound according to the Cleveland criteria.
The perioperative success rate of loading reached 98 %. The clip was loaded with a neck greater than 1 cm in 2 patients. No migration of the clip occurred, no endoleak was detected and no thrombus at the appendage base was detected. One case of periprocedural stroke was recorded. Within follow-up monitoring TIA occurred in 4 patients and no stroke was recorded.
Epicardial LAA occlusion using the AtriClip system is a safe and reproducible method of LAA occlusion and an important alternative in the prevention of stroke.Key words: atrial fibrillation - occlusion of left atrial appendage - stroke.
心房颤动(房颤)与中风的高风险相关。左心耳(LAA)在其发病机制中起主要作用。在非瓣膜性心房颤动中,多达95%的血栓位于心耳。预防中风则在于长期抗凝治疗,然而,这有其局限性和风险。一种替代方法是左心耳封堵术。在我们的报告中,我们想介绍一种使用心外膜系统AtriClip(AtriCure)进行封堵的新可能性。
在2012年7月至2015年9月期间,我们对101例患者进行了左心耳封堵术。平均年龄65±6岁,女性47例,CHA2DS2-VASc评分(均值)2.47(0-6)。随访1837(均值18.5)个月。37例患者同时进行了其他手术,57例患者进行了内镜迷宫术加夹子植入,7例患者单独进行了夹子植入。夹子通过全胸骨切开术、小切口胸廓切开术或胸腔镜植入。根据克利夫兰标准,通过内镜超声评估夹子加载、残余凹陷和内漏情况。
夹子加载的围手术期成功率达到98%。2例患者的夹子加载颈部大于1厘米。未发生夹子移位,未检测到内漏,未检测到心耳基部血栓。记录到1例围手术期中风病例。在随访监测期间,4例患者发生短暂性脑缺血发作(TIA),未记录到中风病例。
使用AtriClip系统的心外膜左心耳封堵术是一种安全且可重复的左心耳封堵方法,是预防中风的重要替代方法。关键词:心房颤动-左心耳封堵-中风