Yu Jiangtao, Chen Hongwu, Post Felix, Muenzel Manuela, Keil Thorsten, Hou Cody R, Zhao Mingzhong, Meng Zhaohui, Jiang Lisheng
Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany.
Clinic for General Internal Medicine and Cardiology, Katholisches Klinikum Koblenz Montabaur, Koblenz, Germany.
Heart Vessels. 2019 Nov;34(11):1858-1865. doi: 10.1007/s00380-019-01428-8. Epub 2019 May 29.
Percutaneous left atrial appendage closure (LAAC) may decrease risks of stroke and bleeding in elderly patients with non-valvular atrial fibrillation (NVAF), but it is still lacking of evidence. The present study aimed at evaluating the efficacy and safety of LAAC in patients with NVAF over 75 years. 351 patients with NVAF who underwent LAAC were retrospectively analyzed on the LAAC procedure characteristics and the clinical follow-up according to age (age ≥ 75 years or < 75 years). Out of the 351 patients, LAA were successfully closed in 347 patients (98.9%), including 341 with Watchman (WM) device and 6 with Amplatzer cardiac plug (ACP) device because of the WM device-incompatible anatomy. There were no significant differences in total LAAC success rate and procedure-related major complications within 7 days between the groups aged ≥ 75 years and aged < 75 years. After a nearly 2-year follow-up, there was an increased trend of major bleedings and all bleedings in the group aged ≥ 75 years, but there were no significant differences between both groups in all-cause death, cardiovascular death, stroke/TIA/system embolism, device thrombus and device gap (> 5 mm). Kaplan-Meier analysis revealed that the relative risk of annual thromboembolic events between the observed values and the expected ones based on CHADS-VASc score in the group aged ≥ 75 years decreased more obviously (61.9% vs. 54.3%); however, the relative risk of bleedings between the observed values and the expected ones based on HAS-BLED score in the younger group aged < 75 years decreased more significantly (59.6% vs. 29.2%). LAAC in patients with advanced age (age ≥ 75 years), has the same level of efficacy, safety and feasibility as in the younger patients aged < 75 years. Thus, LAAC may be an ideal choice to prevent stroke in NVAF patients with advanced age.
经皮左心耳封堵术（LAAC）可能会降低老年非瓣膜性心房颤动（NVAF）患者的中风和出血风险，但仍缺乏证据。本研究旨在评估LAAC对75岁以上NVAF患者的疗效和安全性。对351例行LAAC的NVAF患者，根据年龄（年龄≥75岁或＜75岁）对LAAC手术特征和临床随访情况进行回顾性分析。351例患者中，347例（98.9%）左心耳成功封堵，其中341例使用Watchman（WM）装置，6例因WM装置解剖结构不匹配而使用Amplatzer心脏封堵器（ACP）装置。≥75岁组和＜75岁组之间，总的LAAC成功率和7天内与手术相关的主要并发症无显著差异。经过近2年的随访，≥75岁组的大出血和所有出血有增加趋势，但两组在全因死亡、心血管死亡、中风/短暂性脑缺血发作/系统性栓塞、器械血栓和器械间隙（＞5mm）方面无显著差异。Kaplan-Meier分析显示，≥75岁组观察值与基于CHADS-VASc评分的预期值之间年度血栓栓塞事件的相对风险下降更明显（61.9%对54.3%）；然而，＜75岁较年轻组观察值与基于HAS-BLED评分的预期值之间出血的相对风险下降更显著（59.6%对29.2%）。高龄（年龄≥75岁）患者的LAAC与＜75岁较年轻患者具有相同水平的疗效、安全性和可行性。因此，LAAC可能是预防高龄NVAF患者中风的理想选择。
