Amabile Nicolas, Belfekih Ayoub, Balmette Vincent, Mahmoudi Khalil, Mignot Nicolas, Roig Clemence
Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
Institut Cardiovasculaire Paris Sud, Massy, France.
J Soc Cardiovasc Angiogr Interv. 2024 Mar 22;3(4):101290. doi: 10.1016/j.jscai.2023.101290. eCollection 2024 Apr.
Enlarged left atrium (LA) is frequently identified in patients who undergo left atrial appendage closure (LAAC) and negatively affects the device's final position and intervention results. Steerable delivery sheath (SDS) could represent an option to overcome these difficulties. We aimed to assess the feasibility of SDS-assisted procedures and compare their efficacy to the standard sheath strategy.
This study analyzed patients from our institution's LAAC registry who had severe LA enlargement on CT scan (index LA volume >90 mL/m) and underwent AMULET device implantation between January 2019 and March 2023. The patients underwent postprocedural CT scan to assess the device's position, residual LAA filling, and peridevice leaks.
A total of 195 consecutive patients were screened and 47 (24%) met the inclusion criteria (n = 22 SDS group; n = 25 standard group). There was no difference in baseline clinical, anatomical, or procedural characteristics. The procedural technical success (96%) and complication rates (9% vs 4%; = .59) were comparable in both groups. Post-LAAC CT scans were obtained in 19 SDS group and 22 standard group patients. We observed significantly lower incidences of residual patent LAA (26% vs 72%; = .005), peridevice leaks (16% vs 64%; = .004), and off-axis device position (0% vs 27%; = .02) in SDS compared to the standard group, suggesting a better LAA sealing.
Severe LA enlargement was frequent among LAAC candidates. In this situation, the use of SDS appears feasible and safe, leading to more efficient closures on follow-up imaging without a higher risk of periprocedural complications.
在接受左心耳封堵术（LAAC）的患者中，左心房（LA）增大的情况较为常见，这对装置的最终位置和干预结果产生负面影响。可操纵输送鞘管（SDS）可能是克服这些困难的一种选择。我们旨在评估SDS辅助手术的可行性，并将其疗效与标准鞘管策略进行比较。
本研究分析了我院LAAC登记系统中的患者，这些患者在CT扫描中显示左心房严重增大（索引LA容积>90 mL/m²），并于2019年1月至2023年3月期间接受了AMULET装置植入。患者在术后接受CT扫描，以评估装置位置、左心耳残余充盈情况和装置周围渗漏。
共筛选出195例连续患者，47例（24%）符合纳入标准（SDS组22例；标准组25例）。两组在基线临床、解剖或手术特征方面无差异。两组的手术技术成功率（96%）和并发症发生率（9%对4%；P = 0.59）相当。19例SDS组患者和22例标准组患者进行了LAAC术后CT扫描。与标准组相比，我们观察到SDS组中左心耳残余通畅（26%对72%；P = 0.005）、装置周围渗漏（16%对64%；P = 0.004）和装置偏心位置（0%对27%；P = 0.02）的发生率显著降低，提示左心耳封堵效果更好。
在LAAC候选患者中，严重左心房增大的情况较为常见。在这种情况下，使用SDS似乎可行且安全，在随访成像中能实现更有效的封堵，且围手术期并发症风险不会更高。
