左心耳封堵术后器械相关血栓形成的单中心回顾性研究

Device-related thrombosis after left atrial appendage closure:a single-central retrospective study

目的探讨左心耳封堵术后器械相关血栓形成的发生率、影响因素及其临床预后。方法纳入2014年5月至2018年6月在武汉亚洲心脏病医院心内科接受左心耳封堵术并完成术后45 d经食管超声心动图检查的患者308例。根据术后45 d经食管超声心动图检查是否存在器械相关血栓形成分为器械相关血栓组和无器械相关血栓组。收集并比较两组患者的基线资料、术中资料、术后45 d随访资料及术后中长期随访资料。结果术后45 d经食管超声心动图检查发现7例器械相关血栓形成,左心耳封堵术后器械相关血栓形成的发生率为2.3%(7/308)。两组患者的年龄、性别、身体质量指数、心房颤动类型、高血压病、糖尿病、冠心病、心力衰竭、CHA_(2)DS_(2)-VASc评分、左心房内径、左心耳口径及左心耳体长等基线资料比较,差异均无统计学意义(均P>0.05)。与无器械相关血栓组相比,器械相关血栓组的卒中史占比较高(85.7%比42.5%,P=0.058),HAS-BLED评分较高[(2.6±1.0)分比(1.9±1.1)分,P=0.078],但差异均无统计学意义。两组患者术后即刻残余分流、术后45 d残余分流、封堵器类型及术后抗栓方案比较,差异均无统计学意义(均P>0.05)。多因素Logistic回归分析显示,卒中史是器械相关血栓形成的独立危险因素(OR 8.1,P=0.019)。在术后平均826 d随访时,两组患者的全因死亡率、总出血发生率、脑出血发生率及小出血发生率等比较,差异均无统计学意义(均P>0.05)。与无器械相关血栓组相比,器械相关血栓组的卒中发生率较高(14.3%比1.0%,P=0.092),但差异无统计学意义。然而Kaplan-Meier生存曲线分析结果显示,器械相关血栓形成与卒中事件发生密切相关(HR 16.8,P<0.001)。结论左心耳封堵术后器械相关血栓形成并不常见,卒中史是器械相关血栓形成的独立危险因素,器械相关血栓形成会增加卒中的风险。

Objective This retrospective study aimed to investigate the incidence,risk factors and clinical prognosis of device-related thrombosis(DRT)after percutaneous left atrial appendage closure(LAAC).Methods From May 2014 to June 2018,308 consecutive patients who had undergone LAAC at Wuhan Asia Heart Hospital and accomplished transesophageal echocardiography at postoperative 45 days were included in the study.Patients with DRT were compared with controls who had no DRT.Basic clinical characteristics,procedural characteristics,follow-up data at postoperative 45 days as well as middle-long term follow-up data were collected and compared.Results A total of 7 patients had DRT,and the incidence of DRT at postoperative 45 days was 2.3%(7/308).The basic clinical characteristics,procedural characteristics as well as follow-up data at postoperative 45 days were comparable between the two groups(all P>0.05).Patients with DRT had higher rate of stroke history(85.7%vs.42.5%,P=0.058)and higher HAS-BLED score[(2.6±1.0)vs.(1.9±1.1),P=0.078],but they did not reach statistical signifi cance.Multiple Logistic regression analysis showed that stroke history was the independent risk factor of DRT after LAAC implantation(OR 8.1,P=0.019).After a mean follow-up of 826 days,all-cause mortality,bleeding,intracranial bleeding or minor bleeding rates were not signifi cantly diff erent between the two groups(all P>0.05).Patients with DRT had higher stroke rate(14.3%vs.1.0%,P=0.092),but it did not reach statistical signifi cance.However,Kaplan-Meier curve showed DRT was signifi cantly associated with stroke(HR 16.8,P<0.001).Conclusions DRT after LAAC implantation is not common.Stroke history is the independent risk factor of DRT after LAAC,and DRT did increase the risk of stroke.