Primessnig Uwe, Schrader Helene, Wiedenhofer Julia M, Trippel Tobias D, Parwani Abdul S, Blaschke Florian, Hindricks Gerhard, Falk Volkmar, Dreger Henryk, Sherif Mohammad, Boldt Leif-Hendrik
Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Klinikum, Berlin, Germany.
Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Front Cardiovasc Med. 2024 Jul 18;11:1401974. doi: 10.3389/fcvm.2024.1401974. eCollection 2024.
Percutaneous interventional left atrial appendage occlusion (LAAO) is a reliable, safe, and effective alternative for stroke prevention in selected patients with atrial fibrillation (AF).
In a retrospective observational study, 149 patients underwent LAAO between 2016 and 2022 at the Department of Cardiology of the Charité-Universitätsmedizin Berlin, Campus Virchow, with AF for prevention of thromboembolic complications. We compared patient characteristics, intraoperative details and postoperative outcomes between single-occlusive plug-type (SOPT) and dual-occlusive disc-type (DODT) devices.
In all patients, the device implantation was successful. 60 patients received a SOPT occluder, including Watchman (35%) and Watchman FLX Occluders (65%), while 89 patients received a DODT occluder, including Amplatzer Cardiac Plug (37.1%), the Amplatzer Amulet (25.8%), and the LAmbre occluder (37.1%) systems. Procedure duration was significantly longer for DODT occluder implantation (49 ± 33 vs. 41 ± 25 min, = 0.018). There were no in-hospital deaths or thromboembolic events reported after LAAO in both groups. Beyond that, a low rate of bleeding or access-side-related complications and pericardial tamponades were observed. Anticoagulation at discharge varied. About 60.8% of patients received dual antiplatelet therapy at hospital discharge, and 33.1% received direct oral anticoagulants. A 6-month follow-up was obtained in 85% of the patients. All implanted devices were in the desired position. However, in 5.7% of the patients, a device-related thrombus formation was detected in the SOPT group, while no thrombus was seen in the DODT group ( = 0.11). Thromboembolic events were noticed in 3.1%, without any difference between the device types. There was a statistically non-significant trend for less residual device leaks after SOPT vs. DODT implantation (no leak in 71.7% vs. 62.2%, = 0.07; minor leaks <5 mm, 9.4% vs. 20.3%, = 0.1). In the SOPT group, less bleeding complications were reported after LAAO (11.3% vs. 17.6%, = 0.1).
Our data suggest the safety and efficiency of LAAO with a very high procedural implantation success rate irrespective of the used LAA device. Furthermore, no relevant procedural or device-related complication occurred during the 6-month follow-up in all patients.
经皮介入左心耳封堵术（LAAO）是预防特定心房颤动（AF）患者中风的一种可靠、安全且有效的替代方法。
在一项回顾性观察研究中，2016年至2022年期间，柏林夏里特大学医学院维尔肖校区心内科的149例房颤患者接受了LAAO以预防血栓栓塞并发症。我们比较了单封堵器塞型（SOPT）和双封堵盘型（DODT）装置之间的患者特征、术中细节和术后结果。
所有患者的装置植入均成功。60例患者接受了SOPT封堵器，包括Watchman（35%）和Watchman FLX封堵器（65%），而89例患者接受了DODT封堵器，包括Amplatzer心脏封堵器（37.1%）、Amplatzer Amulet（25.8%）和LAmbre封堵器系统（37.1%）。DODT封堵器植入的手术时间明显更长（49±33分钟对41±25分钟，P = 0.018）。两组LAAO术后均未报告院内死亡或血栓栓塞事件。除此之外，观察到出血或穿刺部位相关并发症以及心包填塞的发生率较低。出院时的抗凝情况各不相同。约60.8%的患者出院时接受双联抗血小板治疗，33.1%的患者接受直接口服抗凝剂。85%的患者进行了6个月的随访。所有植入装置均处于理想位置。然而，SOPT组中5.7%的患者检测到与装置相关的血栓形成，而DODT组未发现血栓（P = 0.11）。血栓栓塞事件发生率为3.1%，装置类型之间无差异。SOPT植入后残余装置渗漏较少，有统计学上无显著差异的趋势（无渗漏71.7%对62.2%，P = 0.07；微小渗漏<5mm，9.4%对20.3%，P = 0.1）。在SOPT组中，LAAO术后报告的出血并发症较少（11.3%对17.6%，P = 0.1）。
我们的数据表明，无论使用何种LAA装置，LAAO均具有安全性和有效性，手术植入成功率非常高。此外，所有患者在6个月随访期间均未发生相关手术或与装置相关的并发症。
