Shen Jiaxu, Chen Yanyan, Wang Liangguo, Wu Shengjie, Zhou Hao, Huang Zhouqing, Chen Yihe, Shi Xiangxiang, Chen Xiao, Wu Xinlei, Xing Jincheng, Wang Zixuan, Xiao Fangyi
Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China.
Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China.
Can J Cardiol. 2025 Jul;41(7):1227-1237. doi: 10.1016/j.cjca.2025.02.018. Epub 2025 Feb 13.
The LAmbre occluder, available in 2 versions, allows for selective coverage of the pulmonary ridge (PR) during left atrial appendage closure (LAAC). In this study we evaluated the effects of PR coverage on imaging and clinical outcomes in patients undergoing LAAC.
Imaging data and clinical events were retrospectively analyzed for patients with nonvalvular atrial fibrillation who successfully underwent LAAC using the LAmbre device at the First Affiliated Hospital of Wenzhou Medical University between October 2018 and May 2022. The primary composite endpoint was thromboembolic (TE) events and device-related thrombus (DRT).
In total, 259 patients were evaluated using transesophageal echocardiography (TEE) at median intervals of 52 days (short term) and 385 days (long term). Patients were divided into a PR-covered group (n = 109) and a PR-uncovered group (n = 150). PR-uncovered patients showed a trend toward higher DRT incidence (8 of 150 vs 1 of 109, P = 0.056, log-rank test). The primary composite endpoint of TE events and DRT was significantly lower in the PR-covered group (14.0% vs 6.4%, P = 0.046, log-rank test). Any peridevice leak (PDL) was more frequent in the PR-covered group during both short-term (45.9% vs 28.7%, P = 0.004) and long-term (49.5% vs 25.3%, P < 0.001) follow-up, but no differences were observed for significant PDLs (> 3 mm). PR coverage was identified as an independent predictor of any long-term PDL (odds ratio 3.19, 95% confidence interval 1.64-6.18, P < 0.001).
PR coverage during LAAC with the LAmbre device was associated with a reduced risk of the primary composite endpoint of TE events and DRT, albeit with an increased incidence of nonsignificant PDL (≤ 3 mm).
LAmbre封堵器有两种型号，可在左心耳封堵术（LAAC）期间选择性覆盖肺嵴（PR）。在本研究中，我们评估了PR覆盖对接受LAAC患者的影像学和临床结局的影响。
对2018年10月至2022年5月在温州医科大学附属第一医院使用LAmbre装置成功进行LAAC的非瓣膜性心房颤动患者的影像学数据和临床事件进行回顾性分析。主要复合终点是血栓栓塞（TE）事件和器械相关血栓（DRT）。
总共259例患者接受了经食管超声心动图（TEE）评估，中位间隔时间分别为52天（短期）和385天（长期）。患者分为PR覆盖组（n = 109）和PR未覆盖组（n = 150）。PR未覆盖的患者DRT发生率有升高趋势（150例中有8例，而109例中有1例，P = 0.056，对数秩检验）。PR覆盖组的TE事件和DRT主要复合终点显著更低（14.0%对6.4%，P = 0.046，对数秩检验）。在短期（45.9%对28.7%，P = 0.004）和长期（49.5%对25.3%，P < 0.001）随访期间，PR覆盖组的任何器械周围渗漏（PDL）更频繁，但对于显著的PDL（> 3 mm）未观察到差异。PR覆盖被确定为任何长期PDL的独立预测因素（比值比3.19，95%置信区间1.64 - 6.18，P < 0.001）。
使用LAmbre装置进行LAAC期间PR覆盖与TE事件和DRT主要复合终点风险降低相关，尽管非显著PDL（≤ 3 mm）的发生率增加。
