Dalio Institute of Cardiovascular Imaging, New York Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA.
Greenberg Cardiology Division, Weill Cornell Medicine, New York, New York, USA.
Cardiology. 2021;146(3):384-391. doi: 10.1159/000513901. Epub 2021 Mar 18.
Left atrial appendage (LAA) closure has recently been approved as an alternative management for stroke prevention in patients with chronic atrial fibrillation who have difficulties with long-term oral anticoagulation. The various shapes and sizes of LAA and orientation of the atrial ostium may contribute to the incomplete LAA closure from circular design devices and orientation of the non-steerable delivery catheter. Incomplete closure of LAA leads to a high-velocity blood flow through the peri-device gap, resulting in peri-device leak (PDL). Residual leaks are frequently diagnosed after LAA closure procedures, regardless of closure methods. There is a controversy in the clinical significance of the leaks, particularly about its association with thromboembolic events. PDL <5 mm was not associated with any increase of risk for thromboembolism. Current literatures with small study population have not been sufficient to clarify the role of the leaks after LAA closure. Nevertheless, management of severe leaks has been a challenging concern for cardiologists. Leaks after epicardial LAA closures are at the neck of the incompletely closed LAA and have shown to increase the risk of thromboembolism. Percutaneous closure of the leaks after LAA closure has been attempted with good safety and success, but long-term safety and efficacy remains unclear. Further large long-term studies which aim to assess the role of leaks or PDLs in predicting thromboembolic events and management strategies are warranted.
左心耳（LAA）封堵术最近已被批准用于因长期口服抗凝治疗有困难而导致的慢性心房颤动患者的卒中预防替代管理。LAA 的各种形状和大小以及心房口的方位可能导致环形设计装置的 LAA 不完全闭合以及不可转向输送导管的方位。LAA 不完全闭合会导致通过设备周围间隙的高速血流，从而导致设备周围漏（PDL）。无论采用何种闭合方法，LAA 闭合术后都会经常诊断出残余漏。关于漏的临床意义存在争议，尤其是其与血栓栓塞事件的关联。PDL <5 mm 与血栓栓塞风险增加无关。目前，由于研究人群较小，文献还不足以阐明 LAA 闭合后漏的作用。尽管如此，严重漏的处理仍然是心脏病专家关注的一个具有挑战性的问题。经心外膜 LAA 闭合术后的漏位于不完全闭合的 LAA 的颈部，已显示出增加血栓栓塞风险。已经尝试了经皮闭合 LAA 闭合术后的漏，具有良好的安全性和成功率，但长期安全性和疗效仍不清楚。需要进一步开展大型长期研究，旨在评估漏或 PDL 在预测血栓栓塞事件和管理策略中的作用。
