Wang Meixiang, Li Wei, Ruan Zhongbao, Zhu Li, Gao Runfeng, Zhao Juan
Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu, China.
Graduate School of Dalian Medical University, Dalian, Liaoning, China.
Surg Innov. 2023 Jun;30(3):303-313. doi: 10.1177/15533506231156687. Epub 2023 Feb 14.
. To evaluate the value of individualized planning of left atrial appendage occlusion (LAAO) using cardiac computed tomography angiography (CCTA) reconstruction techniques. . A total of 96 patients treated for LAAO with the Watchman occluder were included in this study. All patients were randomized by random number table in a 2:1 ratio into the CCTA (+) and CCTA (-) groups according to whether CCTA was performed preoperatively. 3D cardiac reconstruction was performed preoperatively in the CCTA (+) group to plan the location of the atrial septal puncture site, left atrial appendage(LAA) landing zone, predict the size of the occluder and simulate occluder release. In the CCTA(-) group, only transesophageal echocardiography (TEE) and fluoroscopy were used to guide LAAO. . The number of occluders used in a single procedure (1.06 ± .24 vs 1.22 ± .42), the number of intraoperative angiography positions (1.23 ± .58 vs 2.28 ± .85) and the procedure time (45.88 ± 5.08 vs 62.44 ± 5.60) in the CCTA(+) group were lower than in the CCTA(-) group ( < .05), and the first-attempt blocking success rate was higher than that of the CCTA(-) group (85.9% vs 65.6%, = .021). Furthermore, the Bland-Altman plots showed good agreement between the longest diameter of the CCTA-predicted landing zone and the longest diameter of the actual landing zone (95% LoA -7.49, 10.24). A strong positive correlation was observed between the predicted compression ratio and the actual compression ratio (r = .890, < .001). In addition, a strong positive correlation was found between the CCTA-predicted longest diameter of the landing zone and the actual occluder size (r = .863, < .001). . Accurate planning for LAAO using preoperative CCTA can reduce intraoperative angiography positions and occluder changes, shorten the procedure time, increase the success rate of first-attempt blocking and reduce the difficulty of the procedure.
评估使用心脏计算机断层血管造影（CCTA）重建技术进行左心耳封堵术（LAAO）个体化规划的价值。本研究纳入了96例接受Watchman封堵器治疗LAAO的患者。所有患者根据术前是否进行CCTA，通过随机数字表以2:1的比例随机分为CCTA（+）组和CCTA（-）组。CCTA（+）组术前进行三维心脏重建，以规划房间隔穿刺部位、左心耳（LAA）着陆区的位置，预测封堵器大小并模拟封堵器释放。在CCTA（-）组中，仅使用经食管超声心动图（TEE）和荧光透视来指导LAAO。CCTA（+）组单次手术使用封堵器的数量（1.06±0.24对1.22±0.42）、术中血管造影位置的数量（1.23±0.58对2.28±0.85）和手术时间（45.88±5.08对62.44±5.60）均低于CCTA（-）组（P<0.05），首次封堵成功率高于CCTA（-）组（85.9%对65.6%，P=0.021）。此外，Bland-Altman图显示CCTA预测着陆区的最长直径与实际着陆区的最长直径之间具有良好的一致性（95%一致性界限-7.49，10.24）。预测压缩率与实际压缩率之间观察到强正相关（r=0.890，P<0.001）。此外，CCTA预测的着陆区最长直径与实际封堵器大小之间发现强正相关（r=0.863，P<0.001）。使用术前CCTA对LAAO进行准确规划可减少术中血管造影位置和封堵器更换，缩短手术时间，提高首次封堵成功率并降低手术难度。
