Cardiac Surgery Unit, Santa Chira Hospital, Trento, Italy.
Department of Cardiology, Santa Chiara Hospital, Trento, Italy.
J Cardiovasc Electrophysiol. 2020 Aug;31(8):2187-2191. doi: 10.1111/jce.14599. Epub 2020 Jun 17.
The most appropriate treatment for stroke prevention in standalone atrial fibrillation patients with a high CHADS2VASC score contraindicated for oral anticoagulation (OAC) or novel OAC (NOAC) still needs to be defined. Percutaneous left atrial appendage (LAA) closure devices are available, but because of their endocardial positioning need a period of antiplatelet therapy (APT). This study aimed to evaluate the safety and efficacy of epicardial left atrial appendage clipping in patients contraindicated for (N)OAC and APT.
We describe a standalone totally thoracoscopic LAA clipping of forty-five consecutive patients with nonvalvular atrial fibrillation (NVAF; 32 males; age, 73.1 ± 7.4 years; CHADVASC, 6.5 ± 1.1; HAS-BLED 4.9 ± 0.9) with absolute contraindications to (N)OAC. The patients were selected by a multidisciplinary Heart Team. Sixty percent had a previous ischemic stroke and 51% a history of the hemorrhagic event and 22% both. All patients were implanted with an LAA epicardial clip, guided by preoperative computed tomography and intraoperative transesophageal echocardiography. The mean procedural duration was 52.3 ± 12.6 minutes with postprocedural extubation interval of 22.8 ± 14.6 minutes. No procedure-related complications occurred. Intraprocedural transesophageal echocardiography (TEE) showed complete LAA occlusion in all patients. At a mean follow-up of 16.4 ± 9.1 months (range, 2-34), with all patients off (N)OAC or APT, no ischemic stroke or hemorrhagic complications occurred. computed tomography or TEE at follow-up demonstrated a correct LAA occlusion in all with mean stumps of 3.3 ± 2.8 mm.
Thoracoscopic epicardial closure of the LAA with the AtriClip PRO2 device is a potentially safe and efficient treatment for stroke prevention in patients with NVAF contraindicated for anticoagulant therapy or APT.
对于不适合口服抗凝剂（OAC）或新型 OAC（NOAC）治疗且 CHADS2VASC 评分较高的孤立性心房颤动患者，预防中风的最佳治疗方法仍需确定。经皮左心耳（LAA）封堵装置已被应用，但由于其心内膜定位，需要进行一段时间的抗血小板治疗（APT）。本研究旨在评估对不适合（N）OAC 和 APT 的患者行心外膜左心耳夹闭术的安全性和有效性。
我们描述了 45 例连续非瓣膜性心房颤动（NVAF；32 例男性；年龄 73.1±7.4 岁；CHADVASC 评分 6.5±1.1；HAS-BLED 评分 4.9±0.9）患者行单纯全胸腔镜 LAA 夹闭术的经验，这些患者均有绝对的（N）OAC 禁忌证。这些患者由多学科心脏团队选择。60%的患者有既往缺血性中风病史，51%的患者有出血性事件病史，22%的患者同时有这两种病史。所有患者均在术前 CT 及术中经食管超声心动图引导下植入心外膜 LAA 夹。手术平均时长 52.3±12.6 分钟，术后拔管时间间隔为 22.8±14.6 分钟。无手术相关并发症发生。术中经食管超声心动图（TEE）显示所有患者 LAA 完全闭塞。平均随访 16.4±9.1 个月（2-34 个月），所有患者停用（N）OAC 或 APT，无缺血性中风或出血性并发症发生。随访时 CT 或 TEE 显示所有患者 LAA 均正确闭塞，平均残端为 3.3±2.8mm。
使用 AtriClip PRO2 装置经胸腔镜行 LAA 心外膜闭合术是预防 NVAF 患者中风的一种有潜力的安全、有效的治疗方法，这些患者不适合抗凝治疗或 APT。
