左心耳封堵术联合经皮冠状动脉介入术“一站式”手术的有效性及安全性

徐敏敏; 王健; 袁康正; 何胜虎; 柳芳美; 廖清池; 王大新; 邓敏

doi:10.7619/jcmp.20221817

左心耳封堵术联合经皮冠状动脉介入术“一站式”手术的有效性及安全性

1.
大连医科大学临床医学院, 辽宁大连, 116000
2.
江苏省泰州市人民医院心内科, 江苏泰州, 225300
3.
江苏省苏北人民医院心内科, 江苏扬州, 225009
4.
扬州大学临床医学院, 江苏扬州, 225009

详细信息

通讯作者:
邓敏, E-mail: dengmin2046@sina.com

中图分类号: R541.4;R541.7
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出版历程
- 收稿日期: 2022-06-09
- 网络出版日期: 2022-11-03

Effectiveness and safety of “one-stop” surgery of left atrial appendage closure and percutaneous coronary intervention

1.
Clinical Medical College of Dalian Medical University, Dalian, Liaoning, 116000
2.
Department of Cardiology, Taizhou People's Hospital of Jiangsu Province, Taizhou, Jiangsu, 225300
3.
Department of Cardiology, Northern Jiangsu People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225009
4.
Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, 225009

摘要

摘要:
目的
评估冠心病(CAD)合并心房颤动(AF)患者行左心耳封堵术(LAAC)联合经皮冠状动脉介入术(PCI)的有效性及安全性。
方法
回顾性选取接受LAAC联合PCI“一站式”手术的10例CAD合并AF患者作为研究对象, 记录患者的基线资料、围术期治疗情况、严重并发症发生情况和术后抗栓方案，比较患者术前和术后1个月、1年时的超声心动图相关参数和加拿大心血管学会(CCS)心绞痛分级。术后开展电话随访或门诊随访，记录患者用药情况、生存情况和血栓栓塞、大出血事件发生情况。
结果
10例患者房颤脑卒中风险评分(CHA2DS2-VASc评分)为(4.8±1.1)分，出血风险评分(HAS-BLED评分)为(3.8±1.0)分; 左心耳开口直径为(24.6±4.3) mm, 左心耳锚定区直径为(22.8±2.8) mm, 左心耳深度为(32.2±4.4) mm。10例患者术中均成功置入Lambre封堵器，并对病变血管进行支架植入，围术期均未发生血栓栓塞、出血等严重并发症。10例患者平均随访(18.7±3.9)个月，均存活，未发生心肌梗死、缺血性卒中、出血性卒中、血栓栓塞事件，1例患者发生大出血事件, 2例患者发生小出血事件。术后1个月时，患者左心房内径、左心室射血分数、肺动脉压力和二尖瓣反流、三尖瓣反流、主动脉瓣反流情况与术前比较，差异无统计学意义(P>0.05); 术后1个月时，患者CCS心绞痛分级与术前比较，差异有统计学意义(P < 0.05)。术后1年时，患者左心房内径、肺动脉压力和二尖瓣反流、三尖瓣反流、主动脉瓣反流情况与术前比较，差异无统计学意义(P>0.05); 术后1年时，患者左心室射血分数、心绞痛CCS分级与术前比较，差异有统计学意义(P < 0.05)。
结论
LAAC(Lambre封堵器)联合PCI“一站式”手术应用于CAD合并AF患者中安全、可行且有效。
- 心房颤动 /
- 冠心病 /
- 左心耳封堵术 /
- 经皮冠状动脉介入术 /
- Lambre 封堵器
Abstract:
Objective
To evaluate the effectiveness and safety of percutaneous left atrial appendage closure (LAAC) combined with percutaneous coronary intervention (PCI) in patients with coronary heart disease (CAD) and atrial fibrillation (AF).
Methods
A retrospective study was performed in 10 patients with CAD and AF who underwent "one-stop procedure" of LAAC combined with PCI. Baseline data, perioperativetreatment, occurrence of serious complications and postoperative antithrombotic regiments were recorded. Echocardiographic parameters and Canadian Cardiovascular Society (CCS) angina classification were compared before operation and at 1 month and 1 year after operation. Routine postoperative telephone or outpatient follow-up was performed, and the medications, thromboembolism, major bleeding events, and survival of patients were recorded.
Results
The atrial fibrillation stroke risk score (CHA2DS2-VASc score) and bleeding risk score were (4.8±1.1) and (3.8±1.0); the diameter of left atrial appendage opening was (24.6±4.3) mm, the diameter of left atrial appendage anchoring area was (22.8±2.8) mm, and the depth of left atrial appendage was (32.2±4.4) mm. Lambre devices were successfully placed in all 10 patients, and stent implantation was performed in the diseased culprit vessel. No patient had severe complications such as thromboembolism or bleeding during the perioperative period. During follow-up of (18.7±3.9) months, all patients survived, no patient had myocardial infarction, ischemic stroke, hemorrhagic stroke, or thromboembolic events. One patient had massive bleeding and 2 patients had minor bleeding. There were no significant differences in left atrial internal diameter, left ventricular ejection fraction, pulmonary artery pressure, mitral regurgitation, tricuspid regurgitation, and aortic regurgitation of patients 1 month after operation compared with pre-operation (P>0.05). At 1 month after operation, the CCS angina grade showed a significant difference compared with that before operation (P < 0.05). There were no significant differences in left atrial internal diameter, pulmonary artery pressure, mitral regurgitation, tricuspid regurgitation, and aortic regurgitation of patients 1 year after operation compared with pre-operation (P>0.05). There were statistically significant differences in left ventricular ejection fraction and angina pectoris CCS classification of patients 1 year after operation compared with pre-operation(P < 0.05).
Conclusion
The "one-stop" procedure of LAAC (Lambre closure) combined with PCI in patients with CAD and AF is feasible, safe, and effective.
- atrial fibrillation /
- coronary heart disease /
- left atrial appendage closure /
- percutaneous coronary intervention /
- Lambre closure

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表 1 10例患者具体手术情况

序号	麻醉方式	左心耳封堵术						术中肝素使用量/U	经皮冠状动脉介入术
序号	麻醉方式	左心耳形态	左心耳开口直径/mm	左心耳锚定区直径/mm	左心耳深度/mm	封堵器型号	残余漏/mm	术中肝素使用量/U	病变血管	支架尺寸
1	全身麻醉	鸡翅型	24.3	23.8	32.1	24-30	1	7 000	LAD	2.5 mm×29 mm, 2.75 mm×33 mm
2	深度镇静	菜花型	20.1	22.5	21.8	24-30	0	7 000	LAD	2.5 mm×24 mm
3	深度镇静	鸡翅型	25.1	27.0	33.5	28-34	0	6 000	LAD	2.75 mm×23 mm
4	深度镇静	菜花型	31.0	23.8	32.3	26-38	1	11 000	LAD	2.0 mm×38 mm
5	全身麻醉	鸡翅型	19.0	17.0	30.0	18-24	0	10 000	LAD	3.0 mm×23 mm
6	全身麻醉	鸡翅型	29.0	20.0	36.5	22-34	0	8 000	RCA, LCX	3.0 mm×18 mm, 2.5 mm×29 mm
7	深度镇静	鸡翅型	22.0	23.0	29.8	24-30	1	8 000	LCX	2.5 mm×18 mm, 2.5 mm×18 mm, 2.5 mm×15 mm
8	全身麻醉	鸡翅型	21.8	22.0	33.6	24-30	0	6 000	LAD	4.0 mm×15 mm
9	全身麻醉	鸡翅型	22.6	26.0	34.0	28-34	0	12 000	RCA	3.0 mm×30 mm, 3.0 mm×24 mm
10	全身麻醉	鸡翅型	30.7	23.0	37.5	24-30	0	9 000	LAD	3.0 mm×33 mm
LAD: 左前降支; RCA: 右冠状动脉; LCX: 左回旋动脉。

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表 2 患者手术前后超声心动图相关参数和CCS心绞痛分级比较(x±s)[n(%)]

指标	分类	术前(n=10)	术后1个月(n=10)	术后1年(n=8)
左心房内径/mm		40.9±4.5	41.5±4.7	42.6±4.0
左心室射血分数/%		56.4±7.5	56.6±4.8	54.8±4.9^*
肺动脉压力/mmHg		36.2±8.4	36.0±8.5	34.7±7.5
二尖瓣反流	无	3(30.0)	1(10.0)	0
	轻	6(60.0)	7(70.0)	6(75.0)
	中	1(10.0)	2(20.0)	2(25.0)
	重	0	0	0
三尖瓣反流	无	1(10.0)	1(10.0)	1(12.5)
	轻	6(60.0)	6(60.0)	4(50.0)
	中	3(30.0)	3(30.0)	3(37.5)
	重	0	0	0
主动脉瓣反流	无	6(60.0)	6(60.0)	3(37.5)
	轻	4(40.0)	4(40.0)	5(62.5)
	中	0	0	0
	重	0	0	0
CCS心绞痛分级/级		2.3±0.6	0.9±0.3^*	1.1±0.3^*
CCS: 加拿大心血管学会。与术前比较, *P < 0.05。

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