Kang Yoonjin, Hwang Ho Young, Joo Seohee, Park Ji Hyeon, Kim Ji Seong, Sohn Suk Ho, Choi Jae Woong
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
J Thorac Dis. 2021 Nov;13(11):6252-6260. doi: 10.21037/jtd-21-1138.
This study was conducted to compare the efficacy and safety of left atrium appendage (LAA) elimination using stapled excision with those using internal suture obliteration.
In all, 158 patients with atrial fibrillation who underwent surgical elimination of the LAA during cardiac surgery and later underwent postoperative computed tomography (CT) were enrolled. Of these, 102 patients underwent stapled excision (SE group), and 56 underwent internal suture obliteration (IO group). The efficacy endpoint was LAA excision failure, including a remnant LAA (>1 cm) or communication between the left atrium (LA) and LAA. The safety endpoint was bleeding from the elimination site. The CT was performed at a median of 12.8 months (interquartile range, 0.3-39.9) after surgery.
The efficacy endpoint was observed in 5 (4.9%) and 9 patients (16.1%) in the SE and IO groups, respectively (P=0.036). In the SE group, a remnant LAA was found in 5 patients and extravasation of the dye was not observed. In the IO group, a remnant LAA, a communication between the LA and LAA, and both findings were observed in 1, 6, and 2 patients, respectively. The safety endpoint occurred in 12 (11.8%) and 0 patients (0%) in the SE and IO groups, respectively (P=0.009).
Stapled excision of the LAA was associated with a lower rate of LAA elimination failure compared to internal suture obliteration. However, care should be taken to prevent staple-related bleeding.
本研究旨在比较使用吻合器切除与内部缝合闭塞左心耳（LAA）的疗效和安全性。
总共纳入了158例在心脏手术期间接受LAA手术切除并随后接受术后计算机断层扫描（CT）的房颤患者。其中，102例患者接受吻合器切除（SE组），56例接受内部缝合闭塞（IO组）。疗效终点为LAA切除失败，包括残留LAA（>1 cm）或左心房（LA）与LAA之间存在连通。安全终点为切除部位出血。CT在术后中位数12.8个月（四分位间距，0.3 - 39.9）进行。
SE组和IO组分别有5例（4.9%）和9例（16.1%）观察到疗效终点（P = 0.036）。在SE组中，5例患者发现残留LAA，未观察到染料外渗。在IO组中，分别有1例、6例和2例患者观察到残留LAA、LA与LAA之间的连通以及两者情况。SE组和IO组分别有12例（11.8%）和0例（0%）出现安全终点（P = 0.009）。
与内部缝合闭塞相比，LAA吻合器切除与较低的LAA切除失败率相关。然而，应注意预防吻合器相关出血。
