Chanda Arijit, Reilly John P
John Ochsner Heart & Vascular Center, Cardiac Catheterization Laboratory, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121.
John Ochsner Heart & Vascular Center, Cardiac Catheterization Laboratory, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121.
Prog Cardiovasc Dis. 2017 May-Jun;59(6):626-635. doi: 10.1016/j.pcad.2017.04.003. Epub 2017 Apr 28.
More than 2.3 million adults in the United States have atrial fibrillation (AF), which exposes them to a 5-fold increased risk of stroke. The left atrial appendage (LAA) appears to be the source of thrombus formation in the vast majority of these patients. Anticoagulation significantly reduces the risk of stroke, but often we encounter patients who have absolute or relative contraindication to anticoagulation. Percutaneous LAA exclusion offers an alternative to anticoagulation to decrease the risk of stroke. Three device systems are currently available in the United States. The WATCHMAN® device is the most studied and approved by Food and Drug Administration (FDA) to be used in patients with AF unsuitable for anticoagulation who are at a high risk of stroke. The Amulet® device is currently being used as part of the AMPLATZER® Amulet® LAA Occluder trial, which is a non-inferiority randomized trial comparing the Amulet® to the WATCHMAN® device. The third device in use is the LARIAT®, which is an FDA approved snare and pre-tied stich system. It is used to approximate soft tissue which in this case is the LAA. It is a hybrid system and requires both epicardial and endocardial access. The main obstacle to percutaneous LAA closure is procedural related complications, which can be minimized with optimum operator experience.
美国有超过230万成年人患有心房颤动（AF），这使他们中风风险增加了5倍。在绝大多数此类患者中，左心耳（LAA）似乎是血栓形成的源头。抗凝治疗可显著降低中风风险，但我们经常会遇到对抗凝治疗有绝对或相对禁忌证的患者。经皮左心耳封堵术为降低中风风险提供了一种替代抗凝治疗的方法。目前美国有三种器械系统可供使用。WATCHMAN®器械是研究最多且已获美国食品药品监督管理局（FDA）批准，用于不适宜抗凝治疗且中风风险高的房颤患者。Amulet®器械目前正作为AMPLATZER® Amulet®左心耳封堵器试验的一部分使用，该试验是一项非劣效性随机试验，将Amulet®与WATCHMAN®器械进行比较。正在使用的第三种器械是LARIAT®，它是一种经FDA批准的圈套器和预系缝线系统。它用于接近软组织，在这种情况下即左心耳。它是一种混合系统，需要心外膜和心内膜通路。经皮左心耳封堵术的主要障碍是与手术相关的并发症，而最佳的术者经验可将其降至最低。
