D'Abramo Mizar, Romiti Silvia, Saltarocchi Sara, Saade Wael, Spunticchia Flaminia, Bruno Noemi, Peruzzi Mariangela, Miraldi Fabio, Frati Giacomo, Greco Ernesto, Macrina Francesco, De Orchi Paolo, Marullo Antonino G M
Department of Clinical, Internal Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy.
Department of Cardiology, Mediterranea Cardiocentro, 80122 Naples, Italy.
Rev Cardiovasc Med. 2023 Jun 27;24(6):184. doi: 10.31083/j.rcm2406184. eCollection 2023 Jun.
Atrial fibrillation has been identified as an independent risk factor for thromboembolic events. Since 1948 different surgical techniques have described the feasibility and the rationale of left atrial surgical appendage closure. The aim of this systematic review is to evaluate the reported patency rates of different surgical techniques.
This systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two independent investigators searched the PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and OVID® (Wolters Kluwer, Alphen aan den Rijn, Netherlands) to identify relevant studies. Consecutively, a PICO (Population, Intervention, Comparison and Outcomes) strategy assessment of literature was performed to search eventual other relevant studies that may have been ignored.
A total of 42 studies were included in our analysis. The total number of patients who underwent surgical left atrial appendage closure was 5671, and in 61.2% an imaging follow up was performed, mostly with transesophageal echocardiographic evaluation. Success rate for the different techniques was: Clip deployment 98%; Lariat procedure 88%; Surgical amputation 91%; Endocardial suture 74.3%, Epicardial suture 65%; Left atrial appendage closure (LAAC) ligation 60.9%; Stapler technique with excision of left atrial appendage (LAA) 100%; Stapler without excision 70%.
To date, data on surgical left atrial appendage closure are poor and not standardized, even if reported rates are acceptable and comparable to transcatheter procedures. If validated on large-scale non-retrospective and multicentric studies, these promising developments may offer a valuable alternative for patients with atrial fibrillation (AF) and ineligible for oral anticoagulation therapy.
心房颤动已被确定为血栓栓塞事件的独立危险因素。自1948年以来，不同的外科技术描述了左心耳外科封闭术的可行性和基本原理。本系统评价的目的是评估不同外科技术报道的通畅率。
本系统评价按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。两名独立研究者检索了PubMed、Scopus、科学网、Cochrane对照试验中心注册库和OVID®（Wolters Kluwer，荷兰阿尔芬 aan den Rijn）以识别相关研究。随后，对文献进行PICO（人群、干预措施、对照和结局）策略评估，以搜索可能被忽视的其他相关研究。
我们的分析共纳入42项研究。接受左心耳外科封闭术的患者总数为5671例，61.2%的患者进行了影像学随访，主要采用经食管超声心动图评估。不同技术的成功率分别为：夹子置入98%；套索术88%；外科切除术91%；心内膜缝合74.3%，心外膜缝合65%；左心耳封闭术（LAAC）结扎60.9%；带左心耳（LAA）切除的吻合器技术100%；不带切除的吻合器70%。
迄今为止，左心耳外科封闭术的数据较少且不规范，即使报道的成功率可以接受且与经导管手术相当。如果在大规模非回顾性多中心研究中得到验证，这些有前景的进展可能为心房颤动（AF）且不符合口服抗凝治疗条件的患者提供一种有价值的替代方案。
