Kurfirst Vojtech, Mokrácek Aleš, Canádyová Júlia, Frána Radim, Zeman Petr
Department of Cardiac Surgery, Hospital of Ceské Budejovice, Ceské Budejovice, Czech Republic.
Interact Cardiovasc Thorac Surg. 2017 Jul 1;25(1):37-40. doi: 10.1093/icvts/ivx065.
Occlusion of the left atrial appendage (LAA) has become an integral and important part of the surgical treatment of atrial fibrillation. Different methods of surgical occlusion of the LAA have been associated with varying levels of short- and long-term success for closure. The purpose of this study was to evaluate long-term results of epicardial placement and endocardial occlusion in patients undergoing cardiac operative procedures.
A total of 101 patients (average age 65.7 years) undergoing cardiac operative procedures with the epicardial AtriClip Exclusion System of the LAA were enrolled in the study. The AtriClip was placed via a sternotomy or a thoracotomy or from a thoracoscopic approach. Postoperative variables, such as thromboembolic events, clip stability and endocardial leakage around the device, were examined by transoesophageal echocardiography (TEE) and/or computed tomography.
Perioperative clip implantation was achieved in 98% of patients. TEE and/or computed tomography conducted during the follow-up period, comprising 1873 patient-months with a mean duration of 18 ± 11 months, revealed no clip migration, no leakage around the device and no clot formation near the remnant cul-de-sac. During the follow-up period, 4 of the cardiac patients experienced transitory ischaemic attacks, whereas no patient experienced a cerebrovascular attack.
The Epicardial AtriClip Exclusion System of the LAA appears to be a feasable and safe operative method with a high success rate. Long-term follow-up confirmed clip stability, complete occlussion of the LAA and absence of any atrial fibrilation-related thromboembolic events. These results need to be confirmed by a larger, multicentre study.
左心耳封堵术已成为房颤外科治疗中不可或缺的重要组成部分。不同的左心耳外科封堵方法在短期和长期封堵成功率方面各不相同。本研究的目的是评估接受心脏手术的患者采用心外膜放置和心内膜封堵的长期效果。
共有101例（平均年龄65.7岁）接受心脏手术并使用心外膜AtriClip封堵系统封堵左心耳的患者纳入研究。AtriClip通过胸骨切开术、开胸术或胸腔镜入路放置。术后通过经食管超声心动图（TEE）和/或计算机断层扫描检查血栓栓塞事件、夹子稳定性和装置周围的心内膜渗漏等变量。
98%的患者在围手术期成功植入夹子。在为期1873个患者月（平均持续时间为18±11个月）的随访期间进行的TEE和/或计算机断层扫描显示，没有夹子移位，装置周围没有渗漏，残余盲端附近没有血栓形成。在随访期间，4例心脏患者发生短暂性脑缺血发作，而没有患者发生脑血管意外。
左心耳的心外膜AtriClip封堵系统似乎是一种可行且安全的手术方法，成功率很高。长期随访证实了夹子的稳定性、左心耳的完全封堵以及无任何与房颤相关的血栓栓塞事件。这些结果需要通过更大规模的多中心研究来证实。
