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.
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