Salzberg Sacha P, Emmert Maximilian Y, Caliskan Etem
HeartClinic, Hirslanden Hospital, Witellikerstraße 40, 8032, Zurich, Switzerland.
Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Raemistraße 100, 8091, Zurich, Switzerland.
Herzschrittmacherther Elektrophysiol. 2017 Dec;28(4):360-365. doi: 10.1007/s00399-017-0532-0. Epub 2017 Nov 17.
The increasing prevalence of atrial fibrillation with the aging population and its associated major morbidity and mortality due to thromboembolic stroke have resulted in intensive research on stroke prevention or stroke risk reduction strategies. Several surgical techniques for left atrial appendage (LAA) occlusion have evolved over the past decades. Surgeons have been using different techniques leading to highly variable and, in particular, poor data on outcomes. LAA closure is performed either as a concomitant procedure during open-heart surgery or as a stand-alone surgical procedure as part of minimally invasive (mini-thoracotomy or thoracoscopy) arrhythmia surgery. Data on the safety and feasibility of surgical LAA occlusion are derived mainly from nonrandomized case series, observational and cohort studies, or registries with mostly inconclusive and conflicting results. Increased awareness of the high failure rates in attaining complete LAA occlusion, thus avoiding poor surgical techniques (e. g., simple suture ligation, endocardial suturing etc.), and the availability of newer devices (e. g., AtriClip device) have recently led to improved surgical results in the literature. If further validated in large-scale studies, these recent promising developments in the field of surgical LAA treatment seem to offer alternatives for patients ineligible for oral anticoagulation therapy with vitamin K antagonists or newer non-vitamin-K-dependent oral anticoagulants.
随着人口老龄化，心房颤动的患病率不断上升，且由于血栓栓塞性中风，其相关的主要发病率和死亡率也不断增加，这导致了对中风预防或中风风险降低策略的深入研究。在过去几十年中，已经出现了几种用于左心耳（LAA）封堵的手术技术。外科医生一直在使用不同的技术，导致结果数据差异很大，尤其是关于预后的数据很差。LAA封堵可在心脏直视手术期间作为伴随手术进行，也可作为微创（小切口开胸或胸腔镜）心律失常手术的一部分作为独立的外科手术进行。手术LAA封堵的安全性和可行性数据主要来自非随机病例系列、观察性和队列研究或注册研究，结果大多不确定且相互矛盾。对实现完全LAA封堵的高失败率的认识不断提高（从而避免不良的手术技术，如简单缝合结扎、心内膜缝合等），以及新型设备（如AtriClip设备）的出现，最近在文献中导致了手术结果的改善。如果在大规模研究中得到进一步验证，手术LAA治疗领域的这些近期有前景的进展似乎为不符合使用维生素K拮抗剂或新型非维生素K依赖性口服抗凝剂进行口服抗凝治疗条件的患者提供了替代方案。
