Soh Bing Wei Thaddeus, Gracias Carlos Sebastian, Sim Wee Han, Killip Michael, Waters Max, Millar Kevin P, O'Brien Julie M, Kiernan Thomas J, Arnous Samer
Department of Cardiology, University Hospital Limerick, Limerick, Ireland.
Department of Radiology, University Hospital Limerick, Limerick, Ireland.
J Cardiovasc Imaging. 2024 Sep 4;32(1):27. doi: 10.1186/s44348-024-00029-y.
The heterogeneous anatomy of the left atrial appendage (LAA) necessitates preprocedural imaging essential for planning of percutaneous LAA occlusion (LAAO) procedures. While transoesophageal echocardiography (TOE) remains the gold standard, cardiac computed tomography (CT) is becoming increasingly popular. To address the lack of consensus on the optimal imaging modality, we compared the outcomes of preprocedural TOE versus CT for LAAO procedure planning. A retrospective single-center cohort study of all LAAO procedures was performed to compare the outcomes of patients receiving preprocedural TOE versus those receiving CT. The primary outcome was procedural success and rate of major adverse events. The secondary outcomes were total procedure time, rate of device size change, and maximum landing zone diameter. A total of 64 patients was included. Of these, 25 (39.1%) underwent TOE and 39 (60.9%) underwent CT. There was no significant difference in the procedural success rate (96.0% vs. 100%, P = 0.39) or major adverse event rate (4.0% vs. 5.1%, P > 0.99) between TOE and CT patients. Compared with TOE, CT was associated with significantly shorter median procedure time (103 min vs. 124 min, P = 0.02) and a lower rate of device size change (7.7% vs. 28.0%, P = 0.04). Compared to CT, TOE was associated with a significantly smaller mean maximum landing zone diameter (20.8 mm vs. 25.8 mm, P < 0.01) and a higher rate of device upsizing (24.0% vs. 2.6%, P = 0.01). No significant difference in detected residual leak rates was found between TOE and CT (50.0% vs. 52.2%, P > 0.99). Planning of LAAO procedures with CT is associated with a shorter total procedure time and a lower rate of device size change and is less likely to underestimate the maximum landing zone diameter.
左心耳（LAA）的解剖结构具有异质性，这使得术前成像对于经皮左心耳封堵术（LAAO）的手术规划至关重要。虽然经食管超声心动图（TOE）仍是金标准，但心脏计算机断层扫描（CT）正变得越来越受欢迎。为了解决在最佳成像方式上缺乏共识的问题，我们比较了术前TOE与CT用于LAAO手术规划的结果。对所有LAAO手术进行了一项回顾性单中心队列研究，以比较接受术前TOE的患者与接受CT的患者的结果。主要结局是手术成功率和主要不良事件发生率。次要结局是总手术时间、器械尺寸变化率和最大着陆区直径。共纳入64例患者。其中，25例（39.1%）接受了TOE检查，39例（60.9%）接受了CT检查。TOE组和CT组在手术成功率（96.0%对100%，P = 0.39）或主要不良事件发生率（4.0%对5.1%，P > 0.99）方面无显著差异。与TOE相比，CT的中位手术时间显著更短（103分钟对124分钟，P = 0.02），器械尺寸变化率更低（7.7%对28.0%，P = 0.04）。与CT相比，TOE的平均最大着陆区直径显著更小（20.8毫米对25.8毫米，P < 0.01），器械增大率更高（24.0%对2.6%，P = 0.01）。TOE和CT在检测到的残余漏血率方面无显著差异（50.0%对52.2%，P > 0.99）。使用CT进行LAAO手术规划与总手术时间更短、器械尺寸变化率更低相关，并且不太可能低估最大着陆区直径。
