Watchman封堵器左心耳封堵术后残余漏形成相关因素分析

吴大虎; 田为中; 张波; 张继; 朱莉; 陈各才

doi:10.12125/j.chj.202111086

Watchman封堵器左心耳封堵术后残余漏形成相关因素分析

Analysis of related factors of residual leakage after left atrial appendage occlusion with Watchman occluder

摘要

摘要:
目的对Watchman封堵器左心耳封堵术后（LAAO)残余漏形成的相关因素进行分析。
方法回顾性分析泰州市人民医院成功进行LAAO并进行心脏CT血管造影（CCTA）的158例心房颤动患者临床及影像学资料，评估封堵后的疗效，将158例术后患者CCTA检查结果按照有无残余漏分成两组，残余漏组和无残余漏组（跨织物渗漏归于无残余漏组），并研究探讨术后残余漏(PDL)发生机制、影响因子及预防策略。
结果两组患者性别、年龄、房颤类型（阵发性或持续性）、CHA₂DS₂-VAS_c评分、HAS-BLED评分、左心室射血分数、有无高血压、糖尿病的比较，差异无统计学意义，两组患者脑梗史的比较，具有统计学意义（P<0.05）。两组封堵器压缩比、偏心指数、肺动脉收缩压、CCTA测量LAA口部周长比较，差异无统计学意义，两组偏正率≥1例数比较，差异有统计学意义（P<0.05）。158例患者LAAO术后3个月CCTA复查显示封堵器完全封堵48（30%）例，残余分流110（70%）例，包括66（42%）例PDL和44（28%）例跨织物渗漏。两组在封堵器压缩比、偏心指数、肺动脉收缩压、CCTA测量左心耳（LAA）口部周长、手术方式及LAA形态比较，差异无统计学意义，两组偏正率比较有统计学意义（P<0.05）。术后3个月均行CCTA和TEE检查的52例患者中，TEE诊断无PDL患者41例（79%），有PDL患者11例（21%）；CCTA诊断无PDL患者37例（35%），有PDL患者15例（29%），CCTA与TEE对于PDL的检出率具有统计学意义（P<0.01）。
结论 LAAO后PDL的发生率较高，CCTA可以清楚的显示封堵术后情况，尤其是区分PDL和跨织物渗漏，并且可以通过三维重建展示PDL形成的原因，是封堵术后较为理想的随访检查方法。

Abstract:
AIM To evaluate the efficacy of Watchman occluder after left atrial appendage occlusion, to analyze the value of cardiac CT angiography (CCTA) in the diagnosis of peri-device leak after left atrial appendage occlusion and to explore the influencing factors of PDL formation.
METHODS The clinical and imaging data of 158 atrial fibrillation patients who were successfully treated with LAAO and CCTA in Taizhou People's Hospital were retrospectively analyzed to evaluate the efficacy after occlusion. The RESULTS of CCTA of 158 patients were divided into two groups according to whether there was peri-device leakage and no peri-device leakage (cross-fabric leakage was classified as no peri-device group). The pathogenesis, influencing factors and prevention strategies of PDL were also discussed.
RESULTS There was no significant difference in gender, age, type of atrial fibrillation (paroxysmal or persistent), CHA₂DS₂ VASc score, has-bled score, left ventricular ejection fraction, hypertension and diabetes between the two groups. There was significant difference in the history of cerebral infarction between the two groups (P<0.05). There was no significant difference between the two groups in terms of occluder compression ratio, eccentricity index, pulmonary artery systolic pressure and LAA mouth circumference measured by CCTA . There was significant difference between the two groups in terms of deviation rate ≥ 1 case (P<0.05). Three months after laao, CCTA reexamination in 158 patients showed that the occluder completely blocked 48 cases (30%), residual shunt 110 cases (70%), including 66 (42%) cases of PDL and 44 (28%) cases of cross fabric leakage. There was no significant difference between the two groups in occluder compression ratio, eccentricity index, pulmonary artery systolic pressure, left atrial appendage (LAA) mouth circumference measured by CCTA, operation method and LAA shape, and the deviation rate between the two groups was statistically significant (P<0.05). Of the 52 patients who underwent CCTA and tee three months after operation, 41 (79%) had no PDL diagnosed by TEE and 11 (21%) had PDL; 37 patients (35%) without PDL and 15 patients (29%) with PDL were diagnosed by CCTA. The detection rate of PDL by CCTA and TEE was statistically significant (P<0.01).
CONCLUSION The incidence of PDL after LAAO is high. CCTA can clearly display the plugging results, especially distinguish PDL from cross-fabric leakage, and display the cause of PDL formation through three-dimensional reconstruction , which is an ideal follow-up examination method after plugging.

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