Objective: To investigate the clinical effect of transepicardial left atrial appendage closure in patients with heart valve disease and atrial fibrillation. Methods: A total of 59 patients with atrial fibrillation who underwent valve surgery in the First Affiliated Hospital of Bengbu Medical College from June 2019 to December 2021 were selected as the research objects. Patients who underwent transepicardial left atrial appendage closure were divided into the clipping group (n=29) and patients who underwent no transepicardial left atrial appendage closure into the non-clipping group (n=30). The basic data before surgery, perioperative indicators and follow-up data of the two groups of patients were compared. Results: There were no statistically significant differences in age, gender, left atrial (LA) thrombosis, preoperative cardiac function, and other underlying diseases between the two groups of patients (P＞0.05). There was no significant difference in the preoperative color Doppler ultrasound measured results between the two groups of patients (P＞0.05). The preoperative ejection fraction of the clipping group was higher than that of the non-clipping group (P＜0.05). There was no statistically significant difference in surgical procedures between the two groups of patients (P＞0.05). Comparison of perioperative indicators and follow-up data between the two groups showed that the total operative time of the clipping group was longer than that in the non-clipping group, and the difference was statistically significant (P＜0.05). There was no significant difference in the time of cardiopulmonary bypass, ascending aorta occlusion, postoperative hospital stays, recurrence of atrial fibrillation after surgery and stroke incidence between the two groups (P＞0.05). Conclusion: For patients with atrial fibrillation undergoing valve surgery, the transepicardial left atrial appendage closure should be routinely performed, which is simple, practical, safe and economical.
LIU Ge
,
SHI Yu
,
ZHANG Shengqiang
,
DIAO Wenjie
,
SHEN Chongwen
,
SHI Chao
. Clinical efficacy of transepicardial left atrial appendage closure in patients with heart valve disease and atrial fibrillation: experience of a single surgeon[J]. Journal of Baotou Medical College, 2023
, 39(9)
: 49
-53
.
DOI: 10.16833/j.cnki.jbmc.2023.09.010
[1] 庞中一,谢海秀,章晔,等. 心房颤动患者左心房及左心耳血栓形成的危险因素分析[J].心肺血管病杂志,2017,36(3): 185-189.
[2] Agewall S,Camm J. New ESC/ EACTS guidelines for the management of atrial fibrillation[J].Eur Heart J Cardiovasc Pharmacother,2017,3(2): 71-72.
[3] Luigi,Di,Biase,et al. Thrombogenic and arrhythmogenic roles of the left atrial appendage in atrial fibrillation[J].Circulation,2018,138(18): 2036-2050.
[4] 郑帅,张海波,李岩,等. 一种新型左心耳闭合装置的初步实验研究[J].中国胸心血管外科临床杂志,2015(6): 70-75.
[5] Hsu JC,Maddox TM,Kennedy KF. Oral anticoagulant therapy prescription in patients with atrial fibrillation across the spectrum of stroke risk: insights from the NCDR PINNACLE registry[J].JAMA Cardiol,2016,1(1): 55-62.
[6] 杨英,扶泽南,杨龙,等. 左心耳结构复杂性与非瓣膜性心房颤动患者左心耳血栓形成的关系[J].中国循环杂志,2020,35(3): 277-281.
[7] Nissinen M,Lehto J,Biancari F,et al. Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis: CAREAVR study[J].Clin Cardiol,2020,43(4): 401-409.
[8] Friedman DJ,Piccini JP,Wang T,et al. Association between left atrial appendage occlusion and readmission for thromboembolism among patients with atrial fibrillation undergoing concomitant cardiac surgery[J].JAMA,2018,319(4): 365-374.
[9] Yao X,Gersh BJ,Holmes DR,et al. Association of surgical left atrial appendage occlusion with subsequent stroke and mortality among patients undergoing cardiac surgery[J].JAMA,2018,319(20): 2116-2126.
[10] 龚志云,姜胜利,任崇雷,等. 二尖瓣置换术中闭合左心耳预防心房颤动中风的作用[J].中华胸心血管外科杂志,2015,31(8): 457-461.
[11] Whitlock RP,Belley-Cote EP,Paparella D. Left atrial appendage occlusion during cardiac surgery to prevent stroke[J].N Engl J Med,2021,384: 2081-2091.
[12] Healey JS,Crystal E,Lamy A,et al. Left atrial appendage occlusion study (LAAOS): Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke[J].Am Heart J,2005,150(2): 288-293.
[13] Hindricks G,Potpara T,Dagres N,et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)[J].Eur Heart J,2020,42(5): 373-498.
[14] Kanderian AS,Gillinov AM,Pettersson GB,et al. Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography[J].J Am Coll Cardiol,2008,52(11): 924-929.
[15] 徐旖炜,朱云鹏,赵强. 同期外科左心耳闭合应成为房颤患者心脏外科手术术中常规—LAAOS Ⅲ研究述评[J/OL].中国胸心血管外科临床杂志,2021,28(9): 1016-1020
[16] Narayan P. Concomitant left atrial appendage occlusion in patients undergoing cardiac surgery[J].Indian J Thorac Cardiovasc Surg,2021,37(5): 605-607.
[17] Melduni RM,Schaff HV,Lee HC,et al. Impact of left atrial appendage closure during cardiac surgery on the occurrence of early postoperative atrial fibrillation,stroke,and mortality: a propensity score-matched analysis of 10 633 patients [J].Circulation,2017,135(4): 366-378.
[18] Johnsrud DO,Melduni RM,Lahr B,et al. Evaluation of anticoagulation use and subsequent stroke in patients with atrial fibrillation after empiric surgical left atrial appendage closure: a retrospective case-control study[J].Clin Cardiol,2018,41(12): 1578-1582.
[19] Lakkireddy D,Turagam M,Afzal MR,et al. Left atrial appendage closure and systemic homeostasis: The LAA HOMEOSTASIS Study[J].J Am Coll Cardiol,2018,71(2): 135-144.
[20] Velagic V,Asmundis C,Mugnai G,et al. L earning curve using the second-generation cryoballoon ablation[J].J Cardiovasc Med,2017,18(7): 518-527.
