Kiankhooy Armin, Liem Bing, Dunnington Gansevoort H, Pierce Carolyn, Eisenberg Susan J, Burk Shelby, Kaiser Daniel W, Lyons Timothy, Huber Daniel
Cardiothoracic Surgery, Department of Surgery, Adventist Health-St Helena Hospital, CA, USA.
Electrophysiology, Department of Cardiology, 19980University of California San Francisco and San Francisco VA Health Care, CA, USA.
Innovations (Phila). 2022 May-Jun;17(3):209-216. doi: 10.1177/15569845221091998. Epub 2022 May 9.
Left atrial appendage (LAA) occlusion at the time of cardiac surgery in patients with atrial fibrillation has been shown to reduce the incidence of postoperative embolic stroke. However, the optimal method for LAA occlusion is not universally accepted. We sought to examine the safety and effectiveness of LAA occlusion with the AtriClip epicardial occlusion device. Cardiac surgical patients with atrial fibrillation who underwent LAA AtriClip placement were evaluated prospectively. Clip placement and clinical outcomes were examined after 1 year of follow-up with transesophageal echocardiography (TEE). The presence of a 10 mm or greater residual pouch, presence of flow into the LAA, or device-related thrombus (DRT) were considered failures. Ninety-seven patients were analyzed. The mean CHADS-VASc score was 2.4 ± 1.4. The postoperative follow-up period ranged from 366 to 1,693 days (mean 685 days or 1.87 years). Seventy-four AtriClips were placed with video-assisted thoracic surgery, whereas 23 were placed via sternotomy or thoracotomy. Successful closure was found in 96% (93 of 97) of patients at follow-up. Failure occurred in 4 patients. No clip migration or DRT was seen on 3-dimensional imaging. Of all 97 patients, 76 (78%) were on presurgical oral anticoagulation, whereas 5 (5.1%) were on postprocedure oral anticoagulation. There were no postoperative thromboembolic events at the time of the study TEE. The AtriClip epicardial surgical occlusion device can provide an excellent rate of successful closure of the LAA during surgical ablation procedures without DRT.
房颤患者在心脏手术时进行左心耳（LAA）封堵已被证明可降低术后栓塞性中风的发生率。然而，LAA封堵的最佳方法尚未得到普遍认可。我们试图研究使用AtriClip心外膜封堵装置进行LAA封堵的安全性和有效性。对接受LAA AtriClip植入的房颤心脏手术患者进行前瞻性评估。在经食管超声心动图（TEE）随访1年后检查夹子植入情况和临床结果。残余囊袋≥10 mm、LAA内有血流或与装置相关的血栓（DRT）被视为封堵失败。分析了97例患者。平均CHADS-VASc评分为2.4±1.4。术后随访时间为366至1693天（平均685天或1.87年）。74个AtriClip通过电视辅助胸腔镜手术植入，23个通过胸骨切开术或开胸术植入。随访时96%（97例中的93例）的患者封堵成功。4例患者封堵失败。三维成像未发现夹子移位或DRT。97例患者中，76例（78%）术前接受口服抗凝治疗，5例（5.1%）术后接受口服抗凝治疗。在研究TEE检查时未发生术后血栓栓塞事件。AtriClip心外膜手术封堵装置在手术消融过程中可实现较高的LAA成功封堵率，且无DRT。
