三种左心耳封堵器的初步植入经验

Transcatheter left atrial appendage closure:initial experience of implantation with three occluders

目的介绍3种不同形态左心耳封堵器行经皮左心耳封堵术的初步植入经验。方法应用3种封堵器,对60例CHADS2评分≥1分且不适宜口服华法林钠长期抗凝的非瓣膜心房颤动患者行左心耳封堵术。借鉴现有封堵器的标准手术流程,探索新型国产双盘状LAmbre左心耳封堵器的植入方法,并拟应用Overlay技术改良新型国产Lefort和Watchman半球面封堵器的植入流程。封堵成功定义为封堵器周围无残余分流或轻微残余分流(残余分流直径<5mm)。结果 60例患者中,分别应用LAmbre左心耳封堵器54例,Watchman左心耳封堵器2例、Lefort左心耳封堵器4例,无残余分流51例、残余分流直径≤3mm 8例、残余分流直径为3.5mm 1例,提示均封堵成功。手术时间为(67.1±18.0)min,进鞘-出鞘时间为(42.6±16.6)min。封堵器更换10例共11次,平均释放(2.3±1.5)次。术中1例患者因径路损伤出血而输血,无其他严重不良事件发生。结论行左心耳封堵术中,应用LAmbre、Watchman、Lefort 3种左心耳封堵器植入均安全有效。

Objective To present initial experience of implantation with three devices for percutaneous left atrial appendage （LAA） closure. Methods Inclusion criteria of cases： patients had non-valvular atrial fibrillation with a CHADS2 score of at least 1 point and were not candidates for long-term anticoagulation with warfarin. Based on standard operation protocols of I_AA closure, we would like to explore the implantation of newly-designed domestic two-disc occluder named LAmbre. Overlay technique was used to improve implantation of newly-designed domestic semi-spherical occluders named Lefort and the Watchman. Successful occlusion was defined as no flow or slight residual （diameter of residual shunt less than 5 mm） around occlude. Results A total of 60 patients underwent percutaneous LAA closure in this study. Of them, L.Ambre was used in 54, Watchman in 2 and Lefort in 4. All procedures reached the criterion of LAA closure; there were 51 cases without flow and 9 cases with slight residual shunt （diameter≤3 mm in 8 and diameter was 3.5 mm in another one）. The overall mean operation time was （67. 1± 18.0） min, and the time between insertion and extraction was （42.6 ± 16.6） min. Occluder was changed in 10 patients for 11 times with an average of 2.3± 1.5. Bloocl transfusion was performed in one case because of bleeding from pathway injury. But no severe adverse events occurred during the operation. Conclusion LAA closure with newly-designed domestic devices, LAmbre or Lefort and Watchman are safe and effective.