Department of Cardiology, University of Health Sciences Turkey, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turgut Özal Bulvari No:11, Kucukcekmece, 34303, Istanbul, Turkey.
Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey.
J Thromb Thrombolysis. 2021 May;51(4):1078-1089. doi: 10.1007/s11239-020-02291-5. Epub 2020 Sep 30.
Left atrial appendage (LAA) is a common site of thrombus formation especially in patients with atrial fibrillation (AF). Complete surgical LAA closure (cSLC) is the surgical aim, however incomplete surgical LAA closure (iSLC) is not rare. In this study, we aimed to evaluate the risk of thromboembolic complications (TEC) in AF patients with iSLC after mitral valve surgery. A total of 101 AF patients (mean age: 61.8 ± 11.8 years; male:32), who underwent surgical suture ligation during mitral valve surgery were enrolled in this retrospective study. All patients underwent transthoracic and transesophageal echocardiography (TEE) at least 3 months after surgery. The primary outcome was the occurrence of TEC including any ischemic stroke, transient ischemic attack, coronary or peripheral embolism. TEE examination revealed cSLC in 66 (65.3%) and iSLC in 35 patients (34.6%). A total of 12 TECs (11.9%) occurred during a mean follow-up time of 41.1 ± 15.6 months. TECs were found to be significantly higher in the iSLC group (25.7% vs 4.5%, p = 0.002). The prevalence of iSLC was significantly higher in patients with TEC (75 vs. 29.2%, p = 0.002). High CHADS-VASc Score and iSLC were found to be independent predictors of TEC. Long term TEC free survival was found to be significantly decreased in patients with iSLC. The presence of iSLC was associated with a significantly increased risk of TEC in AF patients after mitral valve surgery. Routine intraoperative and postoperative screening for iSLC by TEE and long-term strict anticoagulation therapy are recommended in these patients.
左心耳（LAA）是血栓形成的常见部位，尤其是在心房颤动（AF）患者中。完全手术闭合左心耳（cSLC）是手术目标，但不完全手术闭合左心耳（iSLC）并不少见。在这项研究中，我们旨在评估二尖瓣手术后 iSLC 的 AF 患者发生血栓栓塞并发症（TEC）的风险。共有 101 例接受二尖瓣手术缝线结扎的 AF 患者（平均年龄：61.8±11.8 岁；男性：32 例）纳入本回顾性研究。所有患者均在手术后至少 3 个月接受经胸和经食管超声心动图（TEE）检查。主要结局是 TEC 的发生，包括任何缺血性中风、短暂性脑缺血发作、冠状动脉或外周栓塞。TEE 检查显示 66 例（65.3%）为 cSLC，35 例（34.6%）为 iSLC。在平均 41.1±15.6 个月的随访期间，共发生 12 例 TEC（11.9%）。iSLC 组 TEC 发生率明显较高（25.7% vs. 4.5%，p=0.002）。TEC 患者的 iSLC 患病率明显较高（75% vs. 29.2%，p=0.002）。高 CHADS-VASc 评分和 iSLC 是 TEC 的独立预测因子。发现 iSLC 患者的长期 TEC 无事件生存率明显降低。二尖瓣手术后 AF 患者存在 iSLC 与 TEC 风险显著增加相关。建议对这些患者进行术中及术后 TEE 常规筛查 iSLC，并进行长期严格抗凝治疗。
