Percutaneous left atrial appendage closure with complex anatomy by using the staged 'kissing-Watchman' technology with double devices
Percutaneous left atrial appendage closure with complex anatomy by using the staged 'kissing-Watchman' technology with double devices
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DOI：
10.1016/j.ijcard.2018.05.007
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发表时间：
2018-08-15
影响因子：
3.5
通讯作者：
Yu, Jiangtao
中科院分区：
文献类型：
--
作者：
Jiang, Lisheng;Duenninger, Erich;Yu, Jiangtao
背景：左心耳关闭(LAAC)是预防非瓣膜性心房颤动(NVAF)患者卒中的一种有效的口服抗凝方法。由于左心耳解剖的复杂性，单一装置并不一定能完全闭合。本研究旨在评价分期“亲吻守望者”技术封堵复杂解剖的左心耳的可行性和安全性。方法：本中心自2012年2月至2016年12月，采用“亲吻守望者”技术进行了300例左心耳消融手术，其中7例复杂左心耳置入双装置。结果：7个LAA的解剖形态包括6个菜花和1个鸡翅，每个有2个大叶和一个大的共同开口。两期LAAC在X线曝光时间上无明显差异，但在总操作时间(p=0.0634)、对比度(p=0.0802)和X射线剂量(p=0.0803)方面，前者有高于后者的趋势。除1例发生2 mm外，其余均无严重并发症或严重不良事件发生，包括装置脱位、血栓形成、明显的装置周围渗漏(=5 mm)、心包积液/填塞、卒中/短暂性脑缺血发作/全身性栓塞、死亡和大出血。结论：分期“亲吻守望者”技术是可行和安全的，可为单一装置不能完全闭合复杂解剖结构的左房提供一种封堵策略。(C)2018爱思唯尔B.V.保留所有权利。
Background: Left atrial appendage closure (LAAC) is an efficient alternative of oral anticoagulation to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). Due to complexities of LAA anatomy, a complete closure may not always be obtained with a single device. The aim of this study was to evaluate the feasibility and safety of the staged 'kissing-Watchman' technology to occlude the LAA with complex anatomy.Methods: In our center, among 300 cases underwent LAAC with Watchman device from February 2012 to December 2016, 7 complex LAAs were implanted double devices using the staged 'kissing-Watchman' technology. The anatomic morphology, procedure characteristics and safety were analyzed.Results: Of the 7 LAAs, the anatomic morphology includes 6 cauliflowers and 1 chicken wings, each has 2 big lobes and a large common ostium. In the two-staged LAAC procedures, there were no differences in X-ray exposure time, but the total procedure time (p = 0.0634), contrast volume (p = 0.0802) and X-ray dose (p = 0.0803) in the first procedure showed a tendency over the second. All the procedures were successful, except for one case with a 2mmof peri-device leakage, there were no severe complications or major adverse events including device dislocation, thrombosis, obvious peri-device leakage (= 5 mm), pericardial effusion/tamponade, stroke/transient ischemic attack/systemic embolism, death and major bleeding during the 7-day perioperative period and the 6-month follow-up.Conclusions: The staged 'kissing-Watchman' technology is feasible and safe, which might provide a strategy to occlude the LAA with complex anatomy when an incomplete closure is inevitable with a single device. (C) 2018 Elsevier B.V. All rights reserved.