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JACC:左心耳胸腔镜切除有效预防血栓栓塞复发

2013-02-27 高晓方 译 医学论坛网

左心耳胸腔镜切除血栓栓塞复发

　　日本学者的一项研究表明，左心耳胸腔镜切除安全性较好，并且可使外科医生实现相对简单且完整的左心耳封闭。论文于2013年2月14日在线发表于《美国心脏病学会杂志》（J Am Coll Cardiol）。 　　此项研究共纳入30例曾出现血栓栓塞的患者（平均年龄74 ± 5.0岁）。迫切需要抗凝替代治疗的亚组患者为21例（平均年龄75岁，平均CHA2

　　日本学者的一项研究表明，左心耳胸腔镜切除安全性较好，并且可使外科医生实现相对简单且完整的左心耳封闭。论文于2013年2月14日在线发表于《美国心脏病学会杂志》（J Am Coll Cardiol）。

　　此项研究共纳入30例曾出现血栓栓塞的患者（平均年龄74 ± 5.0岁）。迫切需要抗凝替代治疗的亚组患者为21例（平均年龄75岁，平均CHA2DS2 VAS评分4.5），其中因出血性副作用而禁用华法林者13例，国际标准化比值（INR）无法控制者7例，因抗肿瘤治疗减少华法林用量后立刻出现短暂性脑缺血发作者1例。利用胸腔镜实施左心耳切除。

　　结果显示，左心耳胸腔镜切除平均手术时间为32分钟；2例患者转为开胸手术。左心耳胸腔镜切除未引发死亡和严重并发症。术后3个月的三维增强CT证实了切除的完整性。患者随访时间为1至38个月（平均16 ± 9.7个月）。1例患者于术后28个月因乳腺癌而死亡。尽管终止抗凝治疗，但无患者出现血栓栓塞复发。


Thoracoscopic Stand-Alone Left Atrial Appendectomy for Thromboembolism Prevention in Nonvalvular Atrial Fibrillation

Objectives  
This study sought to evaluate thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation (AF).
Background  
Closing the left atrial appendage (LAA) is an efficacious alternative to oral anticoagulation as prevention against AF-induced thromboembolism, provided that the procedure is safe and complete.
Methods  
Thirty patients (mean age, 74 ± 5.0 years) who had had thromboembolisms were selected. A subgroup of 21 patients (mean age, 75 years; mean CHA2DS2 VASc score, 4.5) urgently needed an alternative treatment to anticoagulation: warfarin was contraindicated due to hemorrhagic side effects in 13, the international normalized ratio was uncontrollable in 7, and transient ischemic attacks had developed immediately after the warfarin dose was reduced for oncological treatment in 1. The LAA was thoracoscopically excised with an endoscopic cutter.
Results  
Thoracoscopic appendectomy (mean operating time, 32 min, switched to mini-thoracotomy in 2 cases) led to no mortality and no major complications. Three-month post-operative 3-dimensional enhanced computed tomography, performed with patients' consent, confirmed the completeness of the appendectomy. Patients have been followed for 1 to 38 months (mean, 16 ± 9.7 months [18 ± 9.4 months for the subgroup]). One patient died of breast cancer 28 months after surgery. Despite discontinued anticoagulation, no patients have experienced recurrence of thromboembolism.
Conclusions  
Thoracoscopic stand-alone appendectomy is potentially safe and may allow surgeons to achieve relatively simple, complete LAA closure. Further experience may demonstrate this technique to be a viable option for thromboembolism prevention in nonvalvular AF.

    

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    2013-05-17 hbwxf

    #JACC#

    0

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    2013-03-01 12498568m50暂无昵称

    #ACC#

    0

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    2013-03-01 yinxm8304

    #胸腔镜#

    0

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    2013-03-01 jxrzshh

    #左心耳#

    0