Park Ji Hyeon, Sohn Suk Ho, Choi Jae Woong, Park Eun Ah, Hwang Ho Young
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Korean J Thorac Cardiovasc Surg. 2020 Jun 5;53(3):127-131. doi: 10.5090/kjtcs.2020.53.3.127.
This study was conducted to evaluate the safety and efficacy of left atrial appendage (LAA) excision using a vascular stapler.
Fifty consecutive patients (mean age, 68±9 years) who underwent LAA excision using a vascular stapler during concomitant cardiac surgery were enrolled. In all patients, the excision site was evaluated using computed tomography at a median of 7 days (interquartile range, 5-13.3 days) postoperatively. The safety endpoint of this study was the occurrence of LAA excision-related events, which were defined as bleeding from the excision site that required reinforcement sutures or reoperation due to excision site bleeding. The efficacy endpoint was LAA excision failure, which was defined as a remnant LAA (a stump >1 cm in maximum length) or extravasation of radiocontrast dye.
LAAs were excised using 60- and 45-mm vascular staplers in 49 patients and 1 patient, respectively. Reinforcement sutures were needed in 4 patients due to staple-line bleeding and in 4 patients due to bleeding of the surrounding tissues. No patient underwent reoperation due to staple-related bleeding. A remnant LAA was observed in 2 patients, while extravasation of radiocontrast dye was not observed in any patients.
LAA excision using a vascular stapler may be an effective technique for LAA exclusion. Delicate handling of the stapler device and LA tissue is required to prevent procedure-related complications.
本研究旨在评估使用血管吻合器进行左心耳（LAA）切除的安全性和有效性。
纳入50例在心脏手术同期使用血管吻合器进行LAA切除的连续患者（平均年龄68±9岁）。所有患者在术后中位时间7天（四分位间距5 - 13.3天）时使用计算机断层扫描评估切除部位。本研究的安全终点是LAA切除相关事件的发生，定义为切除部位出血，因切除部位出血需要加强缝合或再次手术。疗效终点是LAA切除失败，定义为残留LAA（最大长度残端>1 cm）或放射性造影剂外渗。
分别使用60 mm和45 mm血管吻合器切除LAA的患者有49例和1例。4例患者因吻合钉线出血、4例患者因周围组织出血需要加强缝合。无患者因吻合钉相关出血接受再次手术。2例患者观察到残留LAA，无患者观察到放射性造影剂外渗。
使用血管吻合器进行LAA切除可能是一种有效的LAA封堵技术。需要精细操作吻合器装置和LAA组织以预防手术相关并发症。
