Richardson Karl M, Dhaliwal Karanpreet K, Hernandez Sebastian S, Fernando Rohesh J, Singleton Matthew J, Bhave Prashant D
Section on Cardiology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA.
Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
Struct Heart. 2025 Apr 4;9(8):100469. doi: 10.1016/j.shj.2025.100469. eCollection 2025 Aug.
Mounting evidence suggests surgical left atrial appendage (LAA) exclusion reduces stroke risk in patients with atrial fibrillation. Prior older research suggests that LAA exclusion is often incomplete, but few transesophageal echocardiogram (TEE) data exist evaluating LAA remnants.
We analyzed 121 patients with an available postoperative TEE who underwent LAA exclusion by surgical excision (SE), AtriClip occlusion (AO), or Tiger Paw occlusion (TO). TEE images were assessed for LAA remnant depths, presence of flow into remnant, and visible suture, thrombus, or pectinate. Successful LAA exclusion was defined as a remnant with depth past LAA ostium <1 cm in all available imaging angles.
Left atrial appendage exclusion was successful in 99/121 (82%) patients. Success varied numerically but not statistically by technique; 73/85 (86%), 22/29 (76%), 4/7 (57%) in the SE, AO, and TO groups, respectively. SE group had similar mean and max (cm) remnant depths (0.56 ± 0.32 and 0.65 ± 0.38) compared to the AO group (0.68 ± 0.38 and 0.81 ± 0.49) and TO group (0.69 ± 0.30 and 0.83 ± 0.40). Flow into LAA remnant was seen in 4.4% (SE), 15.0% (AO), and 20.0% (TO). Residual pectinate was seen in 18.8% (SE), 13.8% (AO), and 14.3% (TO); 8% in SE group had visible suture. Thrombus was seen in 2 cases within the SE group. In multivariable models, diabetes and heart failure predicted max LAA depth.
Postoperative TEE examination of LAA remnants revealed a relatively high failure rate by current standards. More data are needed to evaluate the clinical relevance of LAA remnant characteristics.
越来越多的证据表明，外科左心耳（LAA）封堵可降低心房颤动患者的中风风险。先前的早期研究表明，LAA封堵往往不完全，但评估LAA残余物的经食管超声心动图（TEE）数据很少。
我们分析了121例术后有可用TEE的患者，这些患者通过手术切除（SE）、AtriClip封堵（AO）或Tiger Paw封堵（TO）进行LAA封堵。评估TEE图像中LAA残余物的深度、有无血流进入残余物以及是否可见缝线、血栓或梳状肌。成功的LAA封堵定义为在所有可用成像角度下，残余物深度超过LAA开口<1cm。
121例患者中有99例（82%）成功进行了左心耳封堵。封堵成功率在数值上因技术而异，但无统计学差异；SE组、AO组和TO组的成功率分别为73/85（86%）、22/29（76%）、4/7（57%）。与AO组（0.68±0.38和0.81±0.49）和TO组（0.69±0.30和0.83±0.40）相比，SE组的平均和最大（cm）残余物深度相似（0.56±0.32和0.65±0.38）。4.4%（SE）、15.0%（AO）和20.0%（TO）的患者可见血流进入LAA残余物。18.8%（SE）、13.8%（AO）和14.3%（TO）的患者可见残余梳状肌；SE组8%的患者可见缝线。SE组有2例患者发现血栓。在多变量模型中，糖尿病和心力衰竭可预测LAA最大深度。
根据当前标准，术后对LAA残余物进行TEE检查显示失败率相对较高。需要更多数据来评估LAA残余物特征的临床相关性。
