Osmancik Pavel, Budera Petr, Zdarska Jana, Herman Dalibor, Petr Robert, Fojt Richard, Straka Zbynek
Cardiology Clinic, Third Department of Internal Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.
Clinic of Cardiac Surgery, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.
Interact Cardiovasc Thorac Surg. 2018 Jun 1;26(6):919-925. doi: 10.1093/icvts/ivx427.
Thoracoscopic occlusion of the left atrial appendage (LAA) has become a routine part of thoracoscopic ablation for the treatment of atrial fibrillation (AF). Evaluation of residual findings of the occluded LAA by echocardiography has yet to be described.
Patients with AF indicated for hybrid ablation (thoracoscopic procedure followed by catheter ablation) were enrolled in this study. LAA was occluded as a routine part of the thoracoscopic procedure. Follow-up transoesophageal echocardiography was performed at the end of the procedure, 2-5 days and 2-3 months after the procedure (before the endocardial stage). The residual pouches of the LAA were measured in the mitral valve view (30-110°) and in the perpendicular view. The depth of the residual pouch was measured from the ostial plane (connecting the Coumadin ridge and the circumflex artery) to the deepest part of the residuum. The volume of the residual pouch and the distance from the circumflex artery to the proximal and the distal ends of the AtriClip were measured using computed tomography.
Forty patients were enrolled in this study. The success rate for the occlusion of the LAA, assessed on transoesophageal echocardiography 2-5 days after surgery, was 97.5%. Regarding the residual findings, no reperfused LAAs were found, and only residual stumps remained. The depth of the stump was 12.9 ± 5.9 mm, the area was 2.2 ± 1.1 cm2, and the volume was 3.6 ± 1.9 ml (all data are shown as mean ± standard deviation).
The occlusion of the LAA using an AtriClip PRO device was a clinically safe procedure with high efficacy and was associated with the presence of a small residual pouch after occlusion.
NCT02832206.
胸腔镜下左心耳（LAA）封堵已成为胸腔镜消融治疗心房颤动（AF）的常规组成部分。尚未见有关通过超声心动图评估封堵后LAA残余情况的报道。
本研究纳入了拟行杂交消融（胸腔镜手术继以导管消融）的AF患者。LAA封堵作为胸腔镜手术的常规部分进行。在手术结束时、术后2 - 5天以及术后2 - 3个月（心内膜阶段之前）进行随访经食管超声心动图检查。在二尖瓣视图（30 - 110°）和垂直视图中测量LAA的残余囊袋。从开口平面（连接华法林嵴和回旋动脉）到残余最深部分测量残余囊袋的深度。使用计算机断层扫描测量残余囊袋的体积以及从回旋动脉到AtriClip近端和远端的距离。
本研究纳入了40例患者。术后2 - 5天经食管超声心动图评估的LAA封堵成功率为97.5%。关于残余情况，未发现再灌注的LAA，仅残留残端。残端深度为12.9±5.9mm，面积为2.2±1.1cm²，体积为3.6±1.9ml（所有数据均以平均值±标准差表示）。
使用AtriClip PRO装置封堵LAA是一种临床安全、疗效高的手术，封堵后会伴有小的残余囊袋。
NCT02832206。
