左心耳封堵术联合房间隔缺损封堵术一站式手术安全性与有效性研究

Safety and efficacy of "one-stop" combining atrial septal defect and left atrial appendage closure

目的探究左心耳(LAA)封堵术(LAAC)联合房间隔缺损(ASD)封堵术一站式手术的有效性与安全性。方法回顾性分析2018年6月至2022年9月在复旦大学附属中山医院接受LAAC联合ASD封堵术一站式手术的心房颤动(房颤)合并ASD患者,收集患者年龄、性别等人口学资料;肺动脉收缩压(PASP)、LAA压力、ASD大小等术中影像学资料;并于术后6个月及12个月随访左心房内径(LAD)、左心室舒张末内径(LVEDD)、左心室射血分数(LVEF)、PASP、三尖瓣反流(TR)程度等超声心动图信息及心电图信息。记录患者是否发生封堵器血栓形成、封堵处残余分流、封堵器故障、心包积液、新发心律失常等术后并发症。结果共纳入32例患者,年龄(68.2±9.3)岁,其中男占34.3%(11/32)例。患者均成功接受LAA联合ASD封堵一站式手术。术中检查封堵器封堵位置合适,固定良好,未发现残余分流等并发症。术后6个月随访时,发现1例患者有细束残余分流及1例患者新发右束支传导阻滞,但术后12个月随访未发现不良事件发生,超声心动图示封堵器形态良好,ASD及LAA封堵器边缘未发现残余血流。结论ASD合并房颤的患者行LAAC及ASD封堵联合的一站式手术是安全、有效的,随访效果良好。

Objective To investigate the effectiveness and safety of"one-stop"combining trial septal defect(ASD)and left atria appendage(LAA)closure(LAAC).Methods Patients with atrial fibrillation(AF)combined with ASD who underwent one-stop surgery for LAAC combined with ASD occlusion at Zhongshan Hospital of Fudan University from June 2018 to September 2022 were retrospectively analyzed,and demographic data such as age and gender;intraoperative imaging data such as pulmonary artery pressure,LAA pressure,and ASD size of atrial septal defect were collected.And left atrial septal defect was followed up at 6 and 12 months after surgery echocardiographic information such as left atrial internal diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP),degree of tricuspid regurgitation(TR)and electrocardiogram(ECG)information were followed up at 6 months and 12 months after surgery.Postoperative complications such as blocker thrombosis,residual shunt at blocker,blocker malfunction,pericardial effusion and new arrhythmias were recorded.Results A total of 32 patients[(68.2±9.3)years],including 11 males(34.3%,11/32)were included in this study,and all patients successfully underwent a combined"one-stop"procedure for LAAC and ASD occlusion.Intraoperatively,the blocker was properly positioned and well fixed,and no complications such as residual shunt were found.One patient was found to have a minor residual shunt,and one patient developed novel right bundle branch block at the 6-month postoperative follow-up,but no adverse events were found at the 12-month postoperative follow-up.Conclusion The combined"one-stop"procedure of LAA and ASD occlusion is safe and effective for patients with ASD combined with AF,with satisfactory follow-up results.