Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, 653100, Yunnan, China.
BMC Cardiovasc Disord. 2022 Jul 23;22(1):326. doi: 10.1186/s12872-022-02770-y.
Percutaneous left atrial appendage (LAA) occlusion is effective for stroke prevention in patients with atrial fibrillation. LAA can have a complex anatomy, such as multiple lobes or a large orifice, which may render it unsuitable for occlusion using regular devices. We aimed to investigate the feasibility, safety, and short-term efficacy of the small-umbrella LAmbre device for morphologically complicated LAA.
We retrospectively enrolled 129 consecutive patients who underwent LAA occlusion using the LAmbre device; the small-umbrella LAmbre device was used in 30 of these patients. We analyzed patients' characteristics, procedural details, and outcomes.
Twenty-two patients (73.3%) had multilobed (≥ 2) LAA. The umbrella of the occluder was anchored in the branch in 9 patients and in the common trunks of branches in 13 patients. The landing zone and orifice diameters were 19.0 ± 4.39 mm and 27.4 ± 3.95 mm, respectively. The sizes of the umbrella and occluder cover were 22.0 ± 3.42 mm and 34.3 ± 2.75 mm, respectively. At 3-month follow-up transesophageal echocardiography in 24 patients, no peri-device residual flow was reported. Device thrombosis was detected in one patient at 3 months and disappeared after 3 months of anticoagulation. Ischemic stroke occurred in one patient; no other adverse events were reported.
Occlusion of morphologically complicated LAA using the small-umbrella LAmbre device was feasible, safe, and effective in patients with atrial fibrillation in this study. This occluder provides an alternative for patients who cannot be treated with regular-sized LAA occlusion devices.
经皮左心耳（LAA）封堵术对于预防房颤患者的中风是有效的。LAA 的解剖结构可能较为复杂，例如存在多个叶瓣或较大的开口，这可能导致其不适合使用常规装置进行封堵。我们旨在研究小伞形 LAmbre 装置用于形态复杂的 LAA 的可行性、安全性和短期疗效。
我们回顾性纳入了 129 例连续接受 LAA 封堵术的患者，其中 30 例患者使用 LAmbre 装置。我们分析了患者的特征、手术细节和结果。
22 例（73.3%）患者存在多叶（≥2 叶）LAA。封堵器的伞形结构在 9 例患者中锚定于分支，在 13 例患者中锚定于分支的共同干。着陆区和开口直径分别为 19.0±4.39mm 和 27.4±3.95mm。伞形和封堵器覆盖物的尺寸分别为 22.0±3.42mm 和 34.3±2.75mm。在 24 例患者的 3 个月经食管超声心动图随访中，未报告设备周围残余分流。1 例患者在 3 个月时发现设备血栓，抗凝治疗 3 个月后消失。1 例患者发生缺血性中风，无其他不良事件报告。
在这项研究中，对于房颤患者，使用小伞形 LAmbre 装置封堵形态复杂的 LAA 是可行、安全且有效的。对于不能接受常规大小的 LAA 封堵装置治疗的患者，这种封堵器提供了一种替代方法。
