左心耳封堵术——预防心房颤动血栓形成新手段
摘要
心房颤动是临床最常见的心律失常之一,血栓栓塞是其严重并发症,具有高致残率和致死率。随着解剖及病理学研究的深入,现已证实血栓主要形成于房颤患者的左心耳。传统的口服抗凝药多具有出血风险、用药禁忌、患者依从性差等不足,通常不能完全达到房颤抗凝的预期效果。外科手术切除左心耳具有创伤大、风险大、并发症多等弊端,多数在外科开胸进行其他手术同时行左心耳切除,也不能在临床推广。经皮左心耳封堵术,以其微创、手术成功率高、并发症少等优势,在预防房颤血栓栓塞中的作用日益被关注。本文就经皮左心耳封堵术优势、有效性、安全性和存在的争议等方面进行综述。
引文
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[6]Bartus K,Han FT,Bednarek J,et al.Percutaneous Left Atrial Appendage Suture Ligation Using the LARIAT Device in Patients With Atrial Fibrillation[J].Journal of the American College of Cardiology,2013,62(2):108-118.DOI:10.1016/j.jacc.2012.06.046.
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[12]刘铮,刘俊,唐闽,等.左心耳封堵预防心房颤动患者血栓栓塞事件[J].中华心律失常学杂志,2016,20(5):377-379,388.DOI:10.3760/cma.j.issn.1007-6638.2016.05.003.
[13]唐恺,张敬莹,赵冬冬,等.左心耳封堵联合导管消融治疗心房颤动的有效性和安全性[J].中华心律失常学杂志,2016,20(5):384-388.DOI:10.3760/cma.j.issn.1007-6638.2016.05.005.
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[17]Jai-Wun Park HSWS,Lopez-Minguez HO.TCT-112 Interim Data from AMPLATZER R Cardiac Plug Registry[J].Journal of the American College of Cardiology,2011,58(20):B33.DOI:10.1016/j.jacc.2011.10.126.
[18]Lam Y,Yip GWK,Yu C,et al.Left atrial appendage closure with Amplatzer cardiac plug for stroke prevention in atrial fibrillation:Initial Asia-Pacific experience[J].Catheterization and Cardiovascular Interventions,2012,79(5):794-800.DOI:10.1002/ccd.23136.
[19]Tzikas A,Shakir S,Gafoor S,et al.Left atrial appendage occlusion for stroke prevention in atrial fibrillation:multicentre experience with the AMPLATZER Cardiac Plug[J].Euro Intervention,2016,11(10):1170-1179.DOI:10.4244/EIJY15M01_06.
[20]Kong B,Liu Y,Lam Y.GW26-e2367 Implantation of LAmbre?left atrial appendage closure device to prevent thrombosis embolism in patients with atrial fibrillation[J].JAm Coll Cardiol,2015,66(16Suppl):C186-C187.DOI:10.1016/j.jacc.2015.06.712.
[21]Lam YY.A new left atrial appendage occluder(Lifetech LAmbre Device)for stroke prevention in atrial fibrillation[J].Cardiovasc Revasc Med,2013,14(3):134-136.DOI:10.1016/j.carrev.2013.04.003.
[22]Boersma LV,Ince H,Kische S,et al.Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation:1-Year follow-up outcome data of the EWOLUTION trial[J].Heart Rhythm,2017,14(9):1302-1308.DOI:10.1016/j.hrthm.2017.05.038.
[23]Seidel A,Parwani AS,Krackhardt F,et al.Safety and efficacy of catheter-based left atrial appendage closure in patients with contraindications for long-term anticoagulation[J].Minerva Cardioangiol,2017,65(6):545-552.DOI:10.23736/S0026-4725.17.04425-5.
[24]Chapeau C,Gutkowska J,Schiller PW,et al.Localization of immunoreactive synthetic atrial natriuretic factor(ANF)in the heart of various animal species[J].J Histochem Cytochem,1985,33(6):541-550.DOI:10.1177/33.6.3158698.
[25]Massoudy P,Beblo S,Raschke P,et al.Influence of intact left atrial appendage on hemodynamic parameters of isolated guinea pig heart[J].Eur J Med Res,1998,3(10):470-474.DOI:10.1136/EMR.3.10.474.
[26]Viles-Gonzalez JF,Kar S,Douglas P,et al.The Clinical Impact of Incomplete Left Atrial Appendage Closure With the Watchman Device in Patients With Atrial Fibrillation[J].Journal of the American College of Cardiology,2012,59(10):923-929.DOI:10.1016/j.jacc.2011.11.028.
[27]Kaul S,Cingolani E,Shehata M,et al.How Does Left Atrial Appendage Occlusion Using The Watchman Device Compare to Dabigatran for Reducing Thromboembolic Events in Patients with Nonvalvular Atrial Fibrillation?[J].Journal of American College of Cardiology,2010,55(10A):A4-A39.DOI:10.1016/S0735-1097(10)60040-X.
[28]Kaneko H,Neuss M,Weissenborn J,et al.Predictors of thrombus formation after percutaneous left atrial appendage closure using the WATCHMAN device[J].Heart and Vessels,2017,32(9):1137-1143.DOI:10.1007/s00380-017-0971-x.
[2]佘飞,刘书旺,郭丽君.左心耳封堵术在心房颤动患者中的应用价值[J].中国心血管杂志,2013,18(6):409-411.DOI:10.3969/j.issn.1007-5410.2013.06.003.
[3]Fukuchi M,Watanabe J,Kumagai K,et al.Increased von Willebrand factor in the endocardium as a local predisposing factor for thrombogenesis in overloaded human atrial appendage[J].J Am Coll Cardiol,2001,37(5):1436-1442.DOI:10.1016/S0735-1097(01)01125-1.
[4]Al-Saady NM,Obel OA,Camm AJ.Left atrial appendage:structure,function,and role in thromboembolism[J].Heart,1999,82(5):547-554.DOI:10.1136/hrt.82.5.547.
[5]黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议-2015[J].中国心脏起搏与心电生理杂志,2015,19(5):377-434.DOI:10.13333/j.cnki.cjcpe.2015.05.001.
[6]Bartus K,Han FT,Bednarek J,et al.Percutaneous Left Atrial Appendage Suture Ligation Using the LARIAT Device in Patients With Atrial Fibrillation[J].Journal of the American College of Cardiology,2013,62(2):108-118.DOI:10.1016/j.jacc.2012.06.046.
[7]张仁宇,林逸贤.经皮左心耳封堵术的并发症和预防方法[J].中华心血管病杂志,2016,44(5):379-381.DOI:10.3760/cma.j.issn.0253-3758.2016.05.005.
[8]Sick PB,Schuler G,Hauptmann KE,et al.Initial Worldwide Experience With the WATCHMAN Left Atrial Appendage System for Stroke Prevention in Atrial Fibrillation[J].Journal of the American College of Cardiology,2007,49(13):1490-1495.DOI:10.1016/j.jacc.2007.02.035.
[9]Reddy VY,Holmes D,Doshi SK,et al.Safety of Percutaneous Left Atrial Appendage Closure:Results From the Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF(PROTECT AF)Clinical Trial and the Continued Access Registry[J].Circulation,2011,123(4):417-424.DOI:10.1161/CIRCULA-TIONAHA.110.976449.
[10]Belgaid DR,Khan Z,Zaidi M,et al.Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy[J].International Journal of Cardiology,2016,219:177-179.DOI:10.1016/j.ijcard.2016.06.041.
[11]张勇华,张劲林,韩宏伟,等.非瓣膜性心房颤动患者行左心耳封堵术的初步结果[J].中国循环杂志,2015,10:989-992.DOI:10.3969/j.issn.1000-3614.2015.10.015.
[12]刘铮,刘俊,唐闽,等.左心耳封堵预防心房颤动患者血栓栓塞事件[J].中华心律失常学杂志,2016,20(5):377-379,388.DOI:10.3760/cma.j.issn.1007-6638.2016.05.003.
[13]唐恺,张敬莹,赵冬冬,等.左心耳封堵联合导管消融治疗心房颤动的有效性和安全性[J].中华心律失常学杂志,2016,20(5):384-388.DOI:10.3760/cma.j.issn.1007-6638.2016.05.005.
[14]Sharma D,Reddy VY,Sandri M,et al.Left Atrial Appendage Closure in Patients With Contraindications to Oral Anticoagulation[J].J Am Coll Cardiol,2016,67(18):2190-2192.DOI:10.1016/j.jacc.2016.02.053.
[15]Jai-Wun Park JPHS,Lars Lickfett JRLH,Benno Hennen KWOO,et al.TCT-86 Results of the Amplatzer Cardiac Plug European Multicenter Prospective Observational Study[J].Journal of the American College of Cardiology,2012,60(17):B27.DOI:10.1016/j.jacc.2012.08.100.
[16]Park J,Bethencourt A,Sievert H,et al.Left atrial appendage closure with amplatzer cardiac plug in atrial fibrillation:Initial european experience[J].Catheterization and Cardiovascular Interventions,2011,77(5):700-706.DOI:10.1002/ccd.22764.
[17]Jai-Wun Park HSWS,Lopez-Minguez HO.TCT-112 Interim Data from AMPLATZER R Cardiac Plug Registry[J].Journal of the American College of Cardiology,2011,58(20):B33.DOI:10.1016/j.jacc.2011.10.126.
[18]Lam Y,Yip GWK,Yu C,et al.Left atrial appendage closure with Amplatzer cardiac plug for stroke prevention in atrial fibrillation:Initial Asia-Pacific experience[J].Catheterization and Cardiovascular Interventions,2012,79(5):794-800.DOI:10.1002/ccd.23136.
[19]Tzikas A,Shakir S,Gafoor S,et al.Left atrial appendage occlusion for stroke prevention in atrial fibrillation:multicentre experience with the AMPLATZER Cardiac Plug[J].Euro Intervention,2016,11(10):1170-1179.DOI:10.4244/EIJY15M01_06.
[20]Kong B,Liu Y,Lam Y.GW26-e2367 Implantation of LAmbre?left atrial appendage closure device to prevent thrombosis embolism in patients with atrial fibrillation[J].JAm Coll Cardiol,2015,66(16Suppl):C186-C187.DOI:10.1016/j.jacc.2015.06.712.
[21]Lam YY.A new left atrial appendage occluder(Lifetech LAmbre Device)for stroke prevention in atrial fibrillation[J].Cardiovasc Revasc Med,2013,14(3):134-136.DOI:10.1016/j.carrev.2013.04.003.
[22]Boersma LV,Ince H,Kische S,et al.Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation:1-Year follow-up outcome data of the EWOLUTION trial[J].Heart Rhythm,2017,14(9):1302-1308.DOI:10.1016/j.hrthm.2017.05.038.
[23]Seidel A,Parwani AS,Krackhardt F,et al.Safety and efficacy of catheter-based left atrial appendage closure in patients with contraindications for long-term anticoagulation[J].Minerva Cardioangiol,2017,65(6):545-552.DOI:10.23736/S0026-4725.17.04425-5.
[24]Chapeau C,Gutkowska J,Schiller PW,et al.Localization of immunoreactive synthetic atrial natriuretic factor(ANF)in the heart of various animal species[J].J Histochem Cytochem,1985,33(6):541-550.DOI:10.1177/33.6.3158698.
[25]Massoudy P,Beblo S,Raschke P,et al.Influence of intact left atrial appendage on hemodynamic parameters of isolated guinea pig heart[J].Eur J Med Res,1998,3(10):470-474.DOI:10.1136/EMR.3.10.474.
[26]Viles-Gonzalez JF,Kar S,Douglas P,et al.The Clinical Impact of Incomplete Left Atrial Appendage Closure With the Watchman Device in Patients With Atrial Fibrillation[J].Journal of the American College of Cardiology,2012,59(10):923-929.DOI:10.1016/j.jacc.2011.11.028.
[27]Kaul S,Cingolani E,Shehata M,et al.How Does Left Atrial Appendage Occlusion Using The Watchman Device Compare to Dabigatran for Reducing Thromboembolic Events in Patients with Nonvalvular Atrial Fibrillation?[J].Journal of American College of Cardiology,2010,55(10A):A4-A39.DOI:10.1016/S0735-1097(10)60040-X.
[28]Kaneko H,Neuss M,Weissenborn J,et al.Predictors of thrombus formation after percutaneous left atrial appendage closure using the WATCHMAN device[J].Heart and Vessels,2017,32(9):1137-1143.DOI:10.1007/s00380-017-0971-x.