AF患者LAAO术前LAA开口参数与术中置入封堵器尺寸的相关性及术后PDL发生的影响因素分析

Analysis on the correlation of preoperative LAA opening parameters with the size of the occluders placed intraoperatively in AF patients undergoing LAAO and the factors influencing the occurrence of postoperative PDL

目的分析心房颤动(AF)患者左心耳封堵(LAAO)术前左心耳(LAA)开口参数与术中置入封堵器尺寸的相关性及术后器械周围残余分流(PDL)发生的影响因素。方法回顾性分析2019年1月至2022年12月于山西医科大学第二医院成功实施LAAO术的83例非瓣膜性AF患者的临床资料。根据术后PDL发生情况将其分为PDL组(23例)和无PDL组(60例)。比较两组患者的临床资料和LAA开口参数。采用Pearson相关分析无PDL组LAA开口参数与术中置入封堵器尺寸的相关性。采用logistic回归分析术后PDL发生的影响因素。结果PDL组年龄显著小于无PDL组(P<0.05),两组性别、合并基础疾病情况比较差异无统计学意义(P>0.05)。PDL组LAA开口长径、短径、周长、面积大于无PDL组,差异有统计学意义(P<0.05)。Pearson相关分析结果显示,无PDL组LAA开口长径、短径、周长、面积与置入封堵器尺寸呈正相关(P<0.05)。多因素logistic回归分析结果显示,较大的年龄是术后PDL发生的独立保护因素,较大的LAA开口短径是术后PDL发生的独立危险因素(P<0.05)。结论LAA开口参数与封堵器尺寸呈正相关,其中LAA开口面积与封堵器尺寸的相关性最好,可为临床上封堵器的选择提供指导作用。较大的年龄是LAAO术后PDL发生的独立保护因素,较大的LAA开口短径是LAAO术后PDL发生的独立危险因素。

Objective To analyze the correlation of preoperative left atrial appendage(LAA)opening parameters with the size of the occluders placed intraoperatively in atrial fibrillation(AF)patients undergoing left atrial appendage occlusion(LAAO)and the factors influencing the occurrence of postoperative peri-device leak(PDL).Methods The clinical data of 83 patients with non-valvular AF who were successfully treated with LAAO in Second Hospital of Shanxi Medical University from January 2019 to December 2022 were retrospectively analyzed.The patients were divided into PDL group(23 cases)and non-PDL group(60 cases)according to the occurrence of postoperative PDL.The clinical data and LAA opening parameters were compared between the patients in the two group.Pearson correlation was used to analyze the correlation of LAA opening parameters with the size of the occluders placed intraoperatively in the non-PDL group.Logistic regression was used to analyze the factors influencing the occurrence of postoperative PDL.Results The patients in the PDL group were significantly younger than those in the non-PDL group(P<0.05).There were no statistically significant differences in gender and combined underlying diseases between the two groups(P>0.05).The long diameter,short diameter,circumference and area of the LAA opening in the PDL group were greater than those in the non-PDL group,and the differences were statistically significant(P<0.05).The results of Pearson correlation analysis showed that the long diameter,short diameter,circumference and area of the LAA opening in the non-PDL group were positively correlated with the size of the placed occluders(P<0.05).The results of multivariate logistic regression analysis showed that older age was an independent protective factor for the occurrence of postoperative PDL(P<0.05),and larger short diameter of LAA opening was an independent risk factor for the occurrence of postoperative PDL(P<0.05).Conclusion LAA opening parameters are positively correlated with the size of occluders,and the LAA opening area has the best correlation with the size of the occluders,which provides guidance for the selection of occluders in clinical practice.Older age is an independent protective factor for the occurrence of PDL after LAAO and larger short diameter of LAA opening is an independent risk factor for the occurrence of PDL after LAAO.