心房颤动合并慢性肾脏病患者行经皮左心耳封堵术有效性及安全性研究

Efficacy and safety of left atrial appendage closure in atrial fibrillation patients with chronic kidney disease

目的探讨非瓣膜性心房颤动合并慢性肾脏病患者行经皮左心耳封堵术(left atrial appendage cloure,LAAC)的安全性及有效性。方法该单中心回顾性研究选取自2018年1月至2019年2月于上海市浦东新区周浦医院心内科接受LAAC的178例非瓣膜性心房颤动患者为研究对象。其中,102例患者无慢性肾脏病(A组),76例患者合并慢性肾脏疾病(B组)。观察两组患者围手术期,手术后3、6、12个月的器械相关血栓(device-related thrombsis,DRT)发生率、血栓栓塞事件发生率和大出血发生率。结果与非CKD组患者相比,CKD组年龄[(77.04±6.37)vs(72.26±7.57)岁,P<0.001]、高血压比例(86.8%vs 65.7%,P=0.001)、心力衰竭比例(34.2%vs 13.7%,P=0.001)、CHA2DS2-VASc评分[(5.04±1.31)vs(4.42±1.57)分,P=0.005]和HAS-BLED评分[(3.53±0.95)vs(2.75±0.85)分,P<0.001]均显著偏高,差异有统计学意义。CKD组植入成功率为100%;非CKD组有1例术后出现封堵器脱落,封堵器植入成功率为99.0%。两组患者围手术期内心包填塞发生率、其他大出血发生率及血栓栓塞事件发生率比较,差异均无统计学意义(均P>0.05)。在术后45~60 d随访时,两组患者DRT发生率、血栓栓塞事件发生率、大出血发生率及死亡发生率比较,差异均无统计学意义(P>0.05)。随访1年时,两组患者血栓栓塞事件发生率、大出血发生率及死亡发生率比较,差异均无统计学意义(P>0.05)。结论心房颤动合并慢性肾脏病行经皮LAAC具有较高的植入成功率,对预防血栓栓塞有良好的安全性和有效性,且不增加出血风险。

Objective To investigate the efficacy and safety of percutaneous left atrial appendage closure(LAAC)in chronic kidney disease patients with non-valvular atrial fibrillation.Methods This single-center retrospective study was performed on 178 patients with nonvalvular atrial fibrillation who received LAAC from January 2018 to February 2019,including 102 patients without chronic kidney disease(group A)and 76 patients with chronic kidney disease(group B).The incidence of device-related thrombosis(DRT),thromboembolism and massive bleeding in the perioperative period and during 3,6,12-month follow-up after LAAC were compared between the two groups.Results Patients with CKD were significantly older[(77.04±6.37)vs(72.26±7.57)years,P<0.001]and had a higher ratio of hypertension(86.8%vs 65.7%,P=0.001),ratio of heart failure(34.2%vs 13.7%,P=0.001),CHA2DS2-VASc score(5.04±1.31 vs 4.42±1.57,P=0.005)and HAS-BLED score(3.53±0.95 vs 2.75±0.85,P<0.001)than patients without CKD.The success rate of implantation in CKD group was 100%,while one patient of non-CKD group suffered from device dislocation with a success implantation rate of 99.0%.During the periprocedural within 7 days,there were no significant difference in the incidence of pericardial tamponade,other massive bleeding and thromboembolic events between the two groups(all P>0.05).In the 45~60 days follow-up,there were no significant difference in the incidence of DRT,thromboembolic,massive bleeding and death events between the two groups(all P>0.05).At 1 year follow-up,there were no significant differences in the incidence of thromboembolism,massive bleeding and the death between the two groups(all P>0.05).Conclusion LAAC in chronic kidney disease patients with non-valvular atrial fibrillation has a high success rate of implantation,which has a good safety and effectiveness for the prevention of stroke and embolism without increasing the risk of bleeding.