Department of Adult Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China.
Department of Adult Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China.
J Thorac Cardiovasc Surg. 2022 Oct;164(4):1106-1116. doi: 10.1016/j.jtcvs.2020.09.139. Epub 2020 Oct 27.
We sought to assess different surgical methods for left atrial appendage treatment to determine whether any could reduce the incidence of atrial fibrillation-related long-term ischemic cerebrovascular accidents.
A total of 1243 patients were treated with left atrial appendage removal, and 107 patients (8.6%) were lost to follow-up and excluded. The primary outcome was the long-term incidence of ischemic cerebrovascular events (ie, ischemic stroke, excluding transient ischemic attack) and all-cause mortality.
Of the 1136 patients, 37 (3.3%) had ischemic cerebrovascular events. The 1-year, 5-year, and 10-year freedoms from long-term ischemic cerebrovascular events of the left atrial appendage extracardiac ligation group were 99.7%, 94.0%, and 90.8%, respectively. The 1-year, 5-year, and 10-year survivals of the left atrial appendage intracardiac suture group were 99.7%, 94.6%, and 93.6%, respectively. There was a significant difference between the left atrial appendage extracardiac ligation group and the left atrial appendage excision group (P = .041). Seventeen patients (4.6%) had long-term ischemic cerebrovascular events in the left atrial appendage extracardiac ligation group (1.1% per year), 14 patients (3.5%) in the left atrial appendage intracardiac suture group (0.9% per year), and 6 patients (1.7%) in the left atrial appendage excision group (0.44% per year). Left atrial appendage excision can reduce the occurrence of long-term thrombotic stroke compared with left atrial appendage extracardiac ligation (95% confidence interval, 1.09-9.26; P = .035).
For patients with atrial fibrillation, the removal of the left atrial appendage can effectively prevent stroke caused by atrial fibrillation.
我们旨在评估左心耳治疗的不同手术方法，以确定是否有任何方法可以降低与房颤相关的长期缺血性脑血管意外的发生率。
共 1243 例患者接受了左心耳切除术，其中 107 例（8.6%）失访并排除。主要结果是长期缺血性脑血管事件（即缺血性卒中和短暂性脑缺血发作除外）和全因死亡率。
在 1136 例患者中，有 37 例（3.3%）发生缺血性脑血管事件。左心耳心外结扎组的 1 年、5 年和 10 年免于长期缺血性脑血管事件的比例分别为 99.7%、94.0%和 90.8%。左心耳心内缝合组的 1 年、5 年和 10 年生存率分别为 99.7%、94.6%和 93.6%。左心耳心外结扎组与左心耳切除组之间存在显著差异（P=0.041）。左心耳心外结扎组有 17 例（4.6%）发生长期缺血性脑血管事件（每年 1.1%），左心耳心内缝合组有 14 例（每年 0.9%），左心耳切除组有 6 例（每年 0.44%）。与左心耳心外结扎相比，左心耳切除可降低长期血栓性卒的发生（95%置信区间，1.09-9.26；P=0.035）。
对于房颤患者，切除左心耳可以有效预防房颤引起的中风。
