Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Semin Thorac Cardiovasc Surg. 2021;33(1):61-67. doi: 10.1053/j.semtcvs.2020.06.041. Epub 2020 Jul 2.
Atrial fibrillation (AF) patients with a previous stroke are often at a high risk of recurrent stroke and bleeding. Anticoagulation therapy in such patients is a challenging dilemma. Thoracoscopic left atrial appendage excision (LAAE) plus AF ablation is an interventional approach offered to some AF patients. We hypothesized that this approach may be suitable as a secondary stroke prevention strategy for these high-risk patients. Between January 2013 and December 2016, a total of 44 patients (26 male; mean age 65.0 ± 9.1 years) with nonvalvular AF and a previous stroke or systemic thromboembolic event were enrolled. The patients underwent thoracoscopic LAAE plus AF ablation by experienced operators and were followed up for 2 years (at 1, 3, 6, 9, and 12 months postoperatively and every 6 months thereafter). Thromboembolic and major bleeding events were recorded. Cerebral computed tomography or magnetic resonance imaging and 7-day Holter monitoring were performed annually. Mean CHADS-VASc and HAS-BLED scores were 4.2 ± 1.2 and 3.3 ± 0.7, respectively. All patients discontinued oral anticoagulation therapy after the surgical intervention. One patient suffered a periprocedural transient ischemic attack, and another was diagnosed with a new ischemic stroke at 491 days after surgery. The annual rate of total thromboembolism was 2.05%. No deaths or major bleeding events were observed postoperatively. The rate of successful AF ablation with no AF recurrence was 76.3%. Transthoracoscopic LAAE plus AF ablation may be a promising approach for this high-risk population. Thromboembolism event in this secondary prevention cohort was low, even without oral anticoagulation treatment.
心房颤动（AF）合并既往卒中的患者常存在较高的卒中复发和出血风险。此类患者的抗凝治疗是一个具有挑战性的难题。胸腔镜左心耳切除术（LAAE）加房颤消融术是为部分房颤患者提供的一种介入治疗方法。我们假设这种方法可能适合作为此类高危患者的二级卒中预防策略。2013 年 1 月至 2016 年 12 月，共纳入 44 例（26 例男性；平均年龄 65.0±9.1 岁）非瓣膜性房颤且合并既往卒中或全身性血栓栓塞事件的患者。由经验丰富的术者对患者进行胸腔镜 LAAE 加房颤消融术，并对患者进行 2 年的随访（术后 1、3、6、9 和 12 个月以及此后每 6 个月）。记录血栓栓塞和大出血事件。每年进行脑计算机断层扫描或磁共振成像和 7 天动态心电图监测。平均 CHADS-VASc 和 HAS-BLED 评分分别为 4.2±1.2 和 3.3±0.7。所有患者在手术干预后均停止口服抗凝治疗。1 例患者在围手术期发生短暂性脑缺血发作，另 1 例患者在术后 491 天被诊断为新发缺血性卒中。总的血栓栓塞年发生率为 2.05%。术后无死亡或大出血事件发生。无房颤复发的房颤消融成功率为 76.3%。胸腔镜 LAAE 加房颤消融术可能是此类高危人群的一种有前途的治疗方法。在没有口服抗凝治疗的情况下，该二级预防队列的血栓栓塞事件发生率较低。
