Transcatheter Patch Occlusion of the Left Atrial Appendage Using Surgical Adhesives in High-Risk Patients With Atrial Fibrillation
Transcatheter Patch Occlusion of the Left Atrial Appendage Using Surgical Adhesives in High-Risk Patients With Atrial Fibrillation
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DOI：
10.1016/j.jacc.2011.08.036
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发表时间：
2011-11-15
影响因子：
24
通讯作者：
Moulopoulos, Spyridon
中科院分区：
文献类型：
--
作者：
Toumanides, Savvas;Sideris, Eleftherios B.;Moulopoulos, Spyridon
目的评估经导管补片（TP）（Custom Medical Devices，Athens，Greece）联合外科粘合剂封堵左心耳（LAA）的有效性。背景TP是一种生物可吸收器械，可根据左心耳的形状和尺寸进行调整，无穿孔风险。它是由外科粘合剂连接，并在45分钟内释放。方法在20例高危患者，59至89岁，房颤进行左心耳封堵术。将2段聚乙二醇外科粘合剂应用于器械的远侧半部分。通过直接注入碱性溶液实现粘合剂的活化。17例患者仅使用荧光镜检查和经食管超声心动图进行器械置入。3例患者还进行了血管造影。结果17例患者手术均获成功。在进行血管造影术的3例患者中，补片未附着并被收回。在1例病例中，补片放置在附件口之外，导致残留开口。随访经食管超声心动图显示闭塞率进一步改善。有1例与手术相关的并发症，即血栓在撤出时从左心房内的长鞘管中释放，需要治疗才能溶解。无复发性卒中的报道。结论封堵术的左心耳的TP是可行的，有效的，在大多数房颤患者的栓塞性卒中的高风险。放置前血管造影可能会影响补片的粘附性，因此禁用。（J Am科尔心脏病学杂志2011;58：2236-40）（C）美国心脏病学会基金会2011年
Objectives The efficacy of left atrial appendage (LAA) occlusion using the Transcatheter Patch (TP) (Custom Medical Devices, Athens, Greece) in conjunction with surgical adhesives was assessed. Background The TP is a bioabsorbable device that can be adjusted for the shape and size of the LAA without the risk of perforation. It is attached by a surgical adhesive and is released in 45 min.Methods Occlusion of the LAA was performed in 20 high-risk patients, 59 to 89 years of age, with atrial fibrillation. A 2-stage polyethylene glycol surgical adhesive was applied to the distal half of the device. Activation of the adhesive was achieved by direct injection of alkaline solution. Fluoroscopy and transesophageal echocardiography only were used for device placement in 17 patients. In 3 patients, angiography was used as well. Follow-up transesophageal echocardiography was performed upon discharge.Results The procedure was successful in 17 cases. In the 3 patients in whom angiography was performed, the patch did not attach and was retrieved. In 1 case, the patch was placed beyond the mouth of the appendage, resulting in a residual opening. There was further improvement of the occlusion rate on the follow-up transesophageal echocardiography. There was 1 complication related to the procedure, namely, thrombus was released from the long sheath in the left atrium upon withdrawal and required treatment to be dissolved. No recurrent strokes were reported.Conclusions Occlusion of the LAA by the TP is feasible and effective in most patients with atrial fibrillation at high risk for embolic stroke. Angiography before placement probably affects patch adhesion and is contraindicated. (J Am Coll Cardiol 2011;58:2236-40) (C) 2011 by the American College of Cardiology Foundation