Chen Tao, Wang Qing-Song, Liu Ge, Lu Xu, Song Ting-Ting, Shi Ming-Yuan, Zhu Hang, Mu Yang, Guo Jun, Chen Yun-Dai
Senior Department of Cardiology, The Sixth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China.
Front Cardiovasc Med. 2022 Mar 22;9:854475. doi: 10.3389/fcvm.2022.854475. eCollection 2022.
Percutaneous left atrial appendage (LAA) occlusion has been considered an efficient alternative to oral anticoagulation to prevent embolic events in patients with non-valvular atrial fibrillation (NVAF). Due to the complexities and heterogeneous anatomy of the LAA structure, the single-device approach may not always fit a large bilobulated LAA. This study aimed to evaluate the feasibility and safety of one-stop dual Watchman implantation for patients with bilobulated LAA.
Included in the analysis were patients who underwent complete LAA closure with dual Watchman devices between December 2015 and December 2021. The anatomic morphology, procedure characteristics, procedure safety, and procedural complications were analyzed. Cardiac CT or transesophageal ultrasound was obtained at 7 days, 6 months, 1 year, and 2 years post-operatively to evaluate the effect of occlusion.
Among the 330 patients who underwent LAA occlusion during the study period, 7 (2.1%) patients were occluded with one-stop implantation of the double Watchman strategy. Successful occlusion was achieved in all patients. One patient had the double-access sheath strategy for implantation, and 6 patients had only a single-access sheath strategy for implantation. Pericardial effusion occurred in one case during the 7-day perioperative period. There was no device embolization, thrombosis, or obvious peridevice leakage (≥l mm) during the 2-year follow-up, with the exception of two cases with 2 mm of incomplete LAA sealing.
The one-stop implantation of a dual Watchman is feasible and safe and might provide a strategy to occlude a large bilobulated LAA when incomplete closure is inevitable with a single device.
经皮左心耳（LAA）封堵术被认为是预防非瓣膜性心房颤动（NVAF）患者发生栓塞事件的一种有效替代口服抗凝治疗的方法。由于LAA结构复杂且解剖结构各异，单器械方法可能并不总是适用于大型双叶LAA。本研究旨在评估一站式双Watchman植入术治疗双叶LAA患者的可行性和安全性。
纳入分析的患者为2015年12月至2021年12月期间接受双Watchman器械完全封堵LAA的患者。分析其解剖形态、手术特点、手术安全性和手术并发症。术后7天、6个月、1年和2年进行心脏CT或经食管超声检查，以评估封堵效果。
在研究期间接受LAA封堵的330例患者中，7例（2.1%）采用一站式双Watchman策略植入封堵成功。所有患者均实现了成功封堵。1例患者采用双入路鞘管策略植入，6例患者仅采用单入路鞘管策略植入。围手术期7天内有1例发生心包积液。在2年随访期间，除2例LAA封堵不完全达2mm外，无器械栓塞、血栓形成或明显的器械周围渗漏（≥1mm）。
一站式双Watchman植入术可行且安全，当单器械不可避免地出现封堵不完全时，可能为封堵大型双叶LAA提供一种策略。
