Pastormerlo Luigi Emilio, De Caterina Alberto Ranieri, Esposito Augusto, Korsholm Kasper, Berti Sergio
UOC Diagnostica Interventistica Fondazione Toscana Gabriele Monasterio Massa, 54100 Massa, Italy.
Department of Cardiology, Aarhus University Hospital, C319, 8200 Aarhus, Denmark.
J Clin Med. 2024 Feb 6;13(4):939. doi: 10.3390/jcm13040939.
Left atrial appendage occlusion (LAAO) is an increasingly used alternative to oral anticoagulation in patients with atrial fibrillation, especially in patients with absolute/relative contraindications to these therapies. This review will cover three main aspects of the procedure. In the fist part of the manuscript, we focus on patient selection. We describe three main categories of patients with primary indication to LAAO, namely patients with previous or at a high risk of intracerebral bleeding, patients with a history of major gastrointestinal bleeding and patients with end-stage renal disease and absolute contraindication to novel oral anticoagulants. Some other potential indications are also described. In the second part of the manuscript, we review available devices, trying to highlight different aspects and potential specific advantages. The last section overviews different ways for pre-, intra- and postprocedural imaging, in order to improve procedural safety and efficacy and ameliorate patient outcome. The characteristics of available contemporary devices and the role of imaging in procedural planning, intraprocedural guidance and follow-up are described.
左心耳封堵术（LAAO）在房颤患者中作为口服抗凝治疗的替代方法使用得越来越多，尤其是在那些对这些治疗有绝对/相对禁忌证的患者中。本综述将涵盖该手术的三个主要方面。在本文的第一部分，我们聚焦于患者选择。我们描述了有LAAO主要适应证的三类主要患者，即既往有脑出血或有脑出血高风险的患者、有重大胃肠道出血史的患者以及患有终末期肾病且对新型口服抗凝药有绝对禁忌证的患者。还描述了一些其他潜在适应证。在本文的第二部分，我们回顾了可用的器械，试图突出不同方面和潜在的特定优势。最后一部分概述了术前、术中和术后成像的不同方式，以提高手术安全性和有效性并改善患者预后。描述了现有当代器械的特点以及成像在手术规划、术中引导和随访中的作用。
