推顶法在LACbes左心耳封堵器植入术中的应用

The application of"pushing and holding"technique in the implantation of LACbes left atrial appendage occluder

国产LACbes左心耳封堵器在经皮左心耳封堵术中的应用越来越广泛。然而由于目前尚缺乏公认的操作方法,术中常出现固定盘放置部位不理想导致反复调整操作,不仅延长手术时间,甚至导致手术失败。本文总结本中心左心耳封堵术的操作经验,提出了推顶固定盘植入的操作技巧。推顶法的要点是在输送鞘管退至固定盘呈倒三角形展开时将输送系统整体向前推送至固定盘前端并越过锚定线,输送鞘管前端远端紧随封堵器推出部分至锚定线附近,继而顶住输送鞘管,推送钢缆以释放固定盘,使固定盘在理想的锚定区释放。推顶法操作可提高固定盘在理想着陆区释放的成功率,缩短手术时间,值得临床推广。

Domestic LACbes left atrial appendage occluder has been more and more widely used in percutaneous left atrial appendage closure(LAAC).However,due to the lack of recognized standard operating methods so far,it is not a uncommon occurrence during LAAC procedure that the anchor cylinder is released to an unsatisfactory location,and it is necessary to adjust its location repeatedly,which not only extends the operation time,but can even lead to surgical failure.This paper summarizes the operation experience of LAAC conducted in authors'cardiac center and introduces the skill of"pushing and holding"technique in the implantation of the anchor cylinder.The key point of"pushing and holding"technique is as follows:the anchor cylinder should be pushed forward to over-cross the anchoring line when the delivery sheath is retracted to the second row of barbs,while the anchor cylinder deploys in an"inverted triangle shape".Then,the distal end of the delivery sheath is pushed to the site near the anchor line.While holding the delivery sheath,push the steel cable to release the anchor cylinder,in this way the anchor cylinder can be released at the desired anchor area.The use of"pushing and holding"technique can increase the success rate of releasing the anchor cylinder in the ideal landing zone and shorten the operation time.Therefore,this"pushing and holding"technique is worthy of clinical promotion.