计算机断层血管造影后计划的左心耳封堵术的中期随访。
Midterm follow-up after computed tomography angiography planned left atrial appendage closure.
机构信息
Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
出版信息
Catheter Cardiovasc Interv. 2024 Jan;103(1):129-136. doi: 10.1002/ccd.30843. Epub 2023 Oct 3.
BACKGROUND
While studies have shown the advantages of computed tomography angiography (CTA) over transesophageal echocardiography (TEE) in left atrial appendage closure (LAAC) preprocedural planning for WATCHMAN™ legacy and FLX devices, there has been no reported long-term data for this approach.
OBJECTIVES
We sought to evaluate long-term outcomes using CTA-based preprocedural planning for LAAC using the WATCHMAN™ device.
METHODS
A prospective analysis of 231 consecutive patients who underwent LAAC in a single, large academic hospital in the United States was conducted over a 5-year period. CTA-guided preprocedural planning was performed in all. Procedural success, adverse events, length of procedure, number of devices used, and length of stay were evaluated. Rates of death, cerebral embolism, systemic embolism, and major and minor bleeding were recorded. Adjusted predicted stroke and major bleeding rates were derived from CHA2DS2-Vasc and HAS-BLED scores, respectively.
RESULTS
From January 26, 2017, to November 23, 2021, 231 patients underwent LAAC with CTA preprocedural planning by two operating physicians. The mean age of patients was 76.5 ± 8.4. 59.7% of patients were male. Mean CHA2DS2VASc and HAS-BLED scores were 4.5 ± 1.4 and 3.9 ± 0.9, respectively. All procedures were performed with intracardiac echo (100%). The procedural success rate was 99.1%. The CTA sizing strategy accurately predicted the implant size in 93.5% of patients. Mean number of devices used was 1.10 ± 0.3. Peri-procedural complication rate was 2.2%. 6 patients were lost to follow-up. Mean follow-up was 608.94 days with a total of 377.04 patient years. Median follow-up period of 368 days (interquartile range: 209-1067 days). There were 51 deaths from all causes (13.52 per 100 patient-years), 10 cases of cerebral embolism (2.65 per 100 patient-years), 2 cases of systemic embolism (0.53 per 100 patient-years), 17 cases of major bleeding (4.50 per 100 patient-years), and 31 cases of minor bleeding (8.2 per 100 patient-years). All-cause mortality at 1, 2, and 3 years was 12.7%, 20.9%, and 29.2%, respectively. CV event rates at 1, 2, and 3 years were 2.1%, 6.6%, and 10.5%, respectively.
CONCLUSIONS
CTA-based preprocedural planning is accurate in predicting device size for LAAC and associated with excellent clinical outcomes at 5 years.
背景
虽然已有研究表明，在 Watchman legacy 和 FLX 装置的左心耳封堵术（LAAC）术前规划中，计算机断层扫描血管造影（CTA）优于经食管超声心动图（TEE），但目前还没有关于这种方法的长期数据报告。
目的
我们旨在评估使用 WATCHMAN 装置进行基于 CTA 的 LAAC 术前规划的长期结果。
方法
对 2017 年 1 月 26 日至 2021 年 11 月 23 日在美国一家大型学术医院接受 LAAC 的 231 例连续患者进行前瞻性分析。所有患者均进行 CTA 引导的术前规划。评估了手术成功率、不良事件、手术时间、使用的装置数量和住院时间。记录了死亡率、脑栓塞、系统性栓塞、大出血和小出血的发生率。来自 CHA2DS2-Vasc 和 HAS-BLED 评分的预测卒中发生率和大出血发生率的调整值分别为。
结果
2017 年 1 月 26 日至 2021 年 11 月 23 日，由两名手术医生对 231 例患者进行了 CTA 引导的 LAAC 术前规划。患者的平均年龄为 76.5±8.4 岁。59.7%的患者为男性。平均 CHA2DS2VASc 和 HAS-BLED 评分分别为 4.5±1.4 和 3.9±0.9。所有手术均采用心内超声（100%）。手术成功率为 99.1%。CTA 测量策略准确预测了 93.5%的患者的植入物尺寸。平均使用装置数量为 1.10±0.3。围手术期并发症发生率为 2.2%。6 例患者失访。平均随访时间为 608.94 天，总随访时间为 377.04 患者年。中位随访时间为 368 天（四分位距：209-1067 天）。共有 51 例患者因各种原因死亡（每 100 患者年 13.52 例），10 例发生脑栓塞（每 100 患者年 2.65 例），2 例发生系统性栓塞（每 100 患者年 0.53 例），17 例发生大出血（每 100 患者年 4.50 例），31 例发生小出血（每 100 患者年 8.2 例）。所有原因死亡率在 1、2 和 3 年分别为 12.7%、20.9%和 29.2%。1、2 和 3 年的心血管事件发生率分别为 2.1%、6.6%和 10.5%。
结论
基于 CTA 的术前规划在预测 LAAC 装置大小方面是准确的，并且在 5 年内具有良好的临床结果。
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