左心耳封堵术后装置不完全内皮化的危险因素及临床影响

Risk factors and clinical implications of incomplete endothelialization of the device after left auricular occlusion

目的探讨心房颤动(房颤)患者左心耳封堵术(LAAC)联合射频消融术后装置不完全内皮化的危险因素及临床影响。方法收集2021年1—12月在阜阳市人民医院接受LAAC联合房颤射频消融术治疗并具有完整随访资料的非瓣膜性房颤患者60例。结果术后3个月中位时间随访,心脏CTA检查发现装置完全内皮化患者19例,不完全内皮化患者37例,存在装置周围残余分流患者4例,所有患者均无不良心脑血管事件;术后6个月中位时间随访检查,发现装置不完全内皮化患者中仍有34例(装置不完全内皮化组)存在内皮化不全,其中有1例装置不完全内皮化患者术后6个月内并发脑卒中,完全内皮化患者22例(装置完全内皮化组),术后6个月4例患者装置残余分流仍然存在。两组患者年龄、性别、身体质量指数、吸烟史、CHA_(2)DS_(2)-VASc评分、HAS-BLED评分、既往病史、术中数据、术后抗凝药物、装置周围残余分流、装置相关血栓(DRT)、不良心脑血管事件比较,差异均无统计学意义(均P>0.05);房颤类型和二尖瓣反流比较,差异均有统计学意义(P=0.011,P=0.029)。以持续性房颤和二尖瓣反流为自变量,装置是否完全内皮化患者为因变量行二元Logistic回归分析,持续性房颤(OR 4.378,95%CI 1.316~14.565,P=0.016)和二尖瓣反流(OR 3.629,95%CI 1.081~12.184,P=0.037)为影响LAAC装置不完全内皮化的独立危险因素。结论装置不完全内皮化在LAAC后常见,尤其是在持续性房颤、二尖瓣反流患者中。装置不完全内皮化在短期可能不会增加DRT及不良心脑血管事件风险。

Objective To investigate the risk factors and clinical effects of incomplete endothelialization of devices after left atrial appendage closure(LAAC)in patients with atrial fi brillation.Methods A total of 60 patients with atrial fibrillation who received left atrial appendage occlusion treatment were collected,and cardiac CTA examination was performed 3 to 6 months after surgery to evaluate whether the closure device was completely endothelialized,and the occurrence of adverse vascular events(bleeding events,stroke,transient cerebral ischemia,etc.)was followed.Results There were 34 patients with incomplete endothelialization in 6 months after operation(incomplete endothelialization group),22 patients with complete endothelialization of devices(complete endothelialization group),and there were no signifi cant diff erences in age,sex,body mass index,smoking history,CHA_(2)DS_(2)-VASc score,HAS-BLED score,past medical history,intraoperative data,postoperative anticoagulant drugs,residual shunt around the device,DRT,and adverse vascular events(all P>0.05),and there were statistically signifi cant diff erences between persistent atrial fi brillation and mitral regurgitation(both P<0.05).Logistic regression analysis showed that persistent atrial fibrillation(OR 4.378,95%CI 1.316~14.565,P=0.016)and mitral regurgitation(OR 3.629,95%CI 1.081~12.184,P=0.037)were independent risk factors for endothelialization of left atrial appendage closure device incompleteness.Conclusions This study suggests that after successful LAAC procedure.a high proportion of patients develop Incomplete endothelialization,particularly in patients with persistent atrial fi brillation and mitral regurgitation.Incomplete endothelialization of devices may not increase the risk of DRT and vascular adverse events in the short term.