Cardiology Department Institut Mutualiste Montsouris Paris France.
Cardiology Department, Inselspital, Bern University Hospital University of Bern Switzerland.
J Am Heart Assoc. 2023 Sep 5;12(17):e030037. doi: 10.1161/JAHA.123.030037. Epub 2023 Aug 23.
Background The interrelationships between left atrial appendage (LAA) dimensions and device following implantation are unknown. We aimed to analyze the impact of Watchman device implantation on LAA dimensions following its percutaneous closure and potential predictors of remodeling. Methods and Results All consecutive LAA closure procedures performed at 2 centers between November 2017 and December 2020 were included in the WATCH-DUAL (Watchman 2.5 Versus Watchman FLX in a Dual-Center Left Atrial Appendage Closure Cohort) registry. This study included patients who had pre- and postintervention computed tomography scan analysis. The LAA and device dimensions were measured in a centralized core lab by 3-dimensional computed tomography scan reconstruction methods, focusing on the device landing zone. This analysis included 104 patients (age, 76.0 [range, 72.0-83.0] years; 72% men; 53% Watchman FLX; 47% Watchman 2.5). The baseline characteristics were comparable between Watchman 2.5 and Watchman FLX groups, except for the higher use of oversizing in the latter group. The median delay for computed tomography control was 49 (range, 43-64) days. The landing zone area (median, 446 [range, 363-523] versus 290 [222-366] mm; <0.001) and minimal diameter (median, 23.0 [range, 20.7-24.8] versus 16.7 [14.7-19.4] mm; <0.001) significantly increased after implantation. The absolute (median, 157 [range, 98-220] versus 85 [18-148] mm, <0.001) and relative (median, 50% [range, 32%-79%] versus 26% [4%-50%]; <0.001) increases in landing zone area were more pronounced in patients with oversized device. Baseline LAA dimensions were smaller, landing zone eccentricity larger, and oversized device more frequent in patients with significant overexpansion compared with the others. Conclusions LAA dimensions increased at the site of the Watchman prosthesis after implantation, suggesting a local positive remodeling after the procedure. This phenomenon was more pronounced in the case of oversized devices.
左心耳（LAA）的尺寸与器械植入后的关系尚不清楚。我们旨在分析 Watchman 器械植入后对 LAA 尺寸的影响及其重塑的潜在预测因素。
本研究纳入了 2017 年 11 月至 2020 年 12 月期间在 2 个中心进行的所有连续 LAA 封堵术，这些患者均在 WATCH-DUAL（Watchman 2.5 与 Watchman FLX 在左心耳封堵术的双中心队列比较）注册研究中进行了术前和术后 CT 扫描分析。通过三维 CT 扫描重建方法，以器械着陆区为重点，在中心化核心实验室测量 LAA 和器械的尺寸。该分析纳入了 104 例患者（年龄 76.0[范围：72.0-83.0]岁；72%为男性；53%为 Watchman FLX；47%为 Watchman 2.5）。除后者组过度覆盖的使用率较高外，Watchman 2.5 组与 Watchman FLX 组的基线特征相当。CT 控制的中位时间为 49（43-64）天。植入后，着陆区面积（中位数：446[范围：363-523]与 290[222-366]mm；<0.001）和最小直径（中位数：23.0[范围：20.7-24.8]与 16.7[14.7-19.4]mm；<0.001）均显著增加。绝对（中位数：157[范围：98-220]与 85[18-148]mm；<0.001）和相对（中位数：50%[范围：32%-79%]与 26%[4%-50%]；<0.001）着陆区面积的增加在使用过度覆盖器械的患者中更为明显。与其他患者相比，在出现显著过度扩张的患者中，基线 LAA 尺寸更小，着陆区偏心度更大，且使用过度覆盖的器械更为常见。
植入后 Watchman 假体部位的 LAA 尺寸增加，提示术后局部发生积极重塑。这种现象在使用过度覆盖器械的患者中更为明显。
