Caliskan Etem, Eberhard Matthias, Falk Volkmar, Alkadhi Hatem, Emmert Maximilian Y
Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Interact Cardiovasc Thorac Surg. 2019 Nov 1;29(5):663-669. doi: 10.1093/icvts/ivz176.
High success rates for left atrial appendage (LAA) exclusion with the AtriClip (Atricure, USA) device have been reported in the literature. This study evaluated the presence and characteristics of residual LAA stumps after AtriClip LAA exclusion using postoperative short- and long-term computed tomography angiography (CTA).
In this retrospective analysis, 43 of 291 consecutive patients undergoing cardiac surgery with concomitant LAA occlusion using the AtriClip device were identified with available postoperative short- and long-term follow-up by CTA. LAA patency and the absence or the size of a present residual LAA stump were assessed on 2-dimensional multiplanar reconstructions, on maximum intensity projection images and on volume-rendered 3-dimensional computed tomography reconstructions. Based on current recommendations, the threshold for a significant LAA stump length was defined <10 mm.
The LAA was successfully occluded in all 43 patients (100%) as confirmed by intraoperative transoesophageal echocardiography and CTA imaging with a mean follow-up duration of 7.1 ± 0.8 years post-implant. The absence of blood flow in the excluded LAA was confirmed in all cases. In 31 of 43 patients (72%), no residual stump (0 mm) was observed creating a smooth endocardial surface, CTA revealed residual LAA stumps in 11/43 patients (26%) with a length <10 mm and a significant residual stump with a depth of >10 mm (12 mm) in 1 patient (2%). The mean length, width and depth of the residual stumps were 5.8 ± 2.1, 4.4 ± 1.2 and 7.3 ± 2.3 mm, respectively.
This study investigated the incidence of residual stump formation (>10 mm) after LAA closure with the AtriClip device based on CTA imaging data obtained during short- and long-term follow-up. While no LAA stump was detectable in the majority of patients, a non-significant LAA stump (<10 mm) was present in 26% of cases, indicating a favourable LAA occlusion profile for the AtriClip device. However, although a LAA stump length <10 mm is currently considered clinically safe, this definition needs further attention in future studies with regards to its potential clinical implications.
文献报道了使用美国Atricure公司的AtriClip装置进行左心耳（LAA）封堵的成功率较高。本研究利用术后短期和长期计算机断层血管造影（CTA）评估AtriClip装置封堵LAA后残余LAA残端的存在情况及特征。
在这项回顾性分析中，291例连续接受心脏手术并同时使用AtriClip装置封堵LAA的患者中，有43例患者术后有可用的短期和长期CTA随访资料。在二维多平面重建、最大密度投影图像和容积再现三维计算机断层扫描重建上评估LAA的通畅情况以及是否存在残余LAA残端及其大小。根据当前建议，将显著LAA残端长度的阈值定义为<10 mm。
术中经食管超声心动图和CTA成像证实，所有43例患者（100%）的LAA均成功封堵，植入后平均随访时间为7.1±0.8年。所有病例均证实被封堵的LAA内无血流。43例患者中有31例（72%）未观察到残余残端（0 mm），形成了光滑的心内膜表面，CTA显示11/43例患者（26%）有长度<10 mm的残余LAA残端，1例患者（2%）有深度>10 mm（12 mm）的显著残余残端。残余残端的平均长度、宽度和深度分别为5.8±2.1、4.4±1.2和7.3±2.3 mm。
本研究基于短期和长期随访期间获得的CTA成像数据，调查了使用AtriClip装置封堵LAA后残余残端形成（>10 mm）的发生率。虽然大多数患者未检测到LAA残端，但26%的病例存在不显著的LAA残端（<10 mm），表明AtriClip装置具有良好的LAA封堵效果。然而，尽管目前认为LAA残端长度<10 mm在临床上是安全的，但鉴于其潜在的临床意义，这一定义在未来研究中需要进一步关注。
