WATCHMAN FLX左心耳封堵器预防房颤患者卒中的国内应用初步分析

Preliminary analysis of domestic application of WATCHMAN FLX left atrial appendage occluder to prevent stroke in patients with atrial fibrillation

目的探讨WATCHMAN FLX左心耳封堵器首次在中国内地应用的安全性、有效性以及手术经验。方法筛选2022年5月就诊于复旦大学附属中山医院心内科的非瓣膜性房颤患者。术前完善心超和CT评估,在经食道超声心动图和数字减影血管造影指导下使用WATCHMAN FLX系统完成经导管左心耳封堵术(transcatheter left atrial appendage occlusion,LAAO),评估手术安全性和封堵即刻有效性,并总结手术经验。结果此封堵器首次应用于中国内地共完成4例手术,其中1例患者行单纯LAAO,其余3例患者行房颤射频消融联合LAAO的“一站式”手术。所有患者均无心包积液、封堵器移位、封堵器脱落、操作相关栓塞、出血、急性器械相关血栓和穿刺部位并发症等不良事件发生。手术即刻封堵成功率为100%,其中3例无任何残余分流,1例有1 mm残余分流。封堵器展开采用FLX BALL的两种新方式:2例采用退鞘法,2例采用推进法。压缩比在13%~28%,封堵器均未露肩。结论WATCHMAN FLX左心耳封堵器有较高的安全性和有效性。

Objective To investigate the safety,efficacy and operational experience of the left atrial appendage occluder-WATCHMAN FLX for the first time in China's Mainland.Methods Patients with non-valvular atrial fibrillation who were admitted to the Department of Cardiology,Zhongshan Hospital Affiliated to Fudan University in May 2022 were screened.We completed echocardiography and CT evaluation before operation,and used WATCHMAN FLX system to complete transcatheter left atrial appendage occlusion(LAAO)under the guidance of transesophageal echocardiography and digital subtraction angiography(DSA),then evaluated the safety and immediate effectiveness,and summarized the operational experience.Results This occluder was used for the first time in China's Mainland,and a total of 4 operations were completed,of which 1 patient underwent LAAO alone,and the remaining 3 patients underwent"one-stop"of atrial fibrillation radiofrequency ablation combined with LAAO.There were no adverse events such as pericardial effusion,occluder displacement,occluder detachment,procedure-related embolism,bleeding,acute device-related thrombosis,or puncture site complications in all the patients.The success rate of immediate closure was 100%,3 cases had no residual shunt,and 1 case had a 1 mm residual shunt.Two new ways of FLX BALL were adopted for the deployment of the occluder:2 cases used the retraction method and 2 cases used the push method.The compression ratio range was 13%-28%,and the devices were not offensive.Conclusion The left atrial appendage occluder-WATCHMAN FLX has high safety and efficacy.