左心耳封堵术后影响封堵器不完全内皮化的危险因素

目的 分析心房颤动（AF）患者左心耳封堵（LAAO）术后封堵器不完全内皮化的影响因素。方法 回顾性分析53例接受LAAO（封堵装置均为Watchman）治疗的AF患者。于术后3个月以双源CT评估封堵器是否完全内皮化；采用单因素及多因素logistic回归分析观察封堵器不完全内皮化的影响因素。结果 术后随访77~134天，中位随访时间100天。术后3个月，双源CT诊断不完全内皮化32例（不完全组）、完全内皮化21例（完全组）；组间左心室射血分数（LVEF）和二尖瓣反流（MR）差异有统计学意义（P均<0.05），性别、年龄、AF类型等指标差异均无统计学意义（P均>0.05）。以LVEF和MR为自变量、完全内皮化与否为因变量行logistic回归分析，结果显示LVEF和MR均为封堵器不完全内皮化的独立影响因素（P均<0.05）。结论 二尖瓣轻度及以上反流及低射血分数可在一定程度上影响LAAO治疗AF术后封堵器内皮化，导致封堵器延迟内皮化或内皮化不完全。

Risk factors of incomplete occluder endothelialization after occlusion of left atrial appendage

Objective To analyze the risk factors of incomplete occluder endothelialization after left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF). Methods Data of 53 patients with AF who underwent LAAO using Watchman occluding device were retrospectively analyzed. Three months after LAAO, dual-source CT scanning was performed to evaluate whether the occluder had completely endothelialized. Single-factor and multi-factor logistic regression were used to observe the risk factors of incomplete occluder endothelialization. Results The patients were followed-up for 77 to 134 days postoperatively, with a median follow-up time of 100 days. Three months after operation, incomplete endothelialization was diagnosed in 32 cases (incomplete group), while complete endothelialization of occlude was detected in 21 cases (complete group)with dual-source CT. There were statistical differences of left ventricular ejection fraction (LVEF) and mild upper mitral regurgitation (MR) between groups (all P<0.05), while there was no significant difference of gender, age, AF type and other indicators between groups (all P>0.05).Taken LVEF and MR as the independent variables and whether complete endothelialization as the dependent variable, logistic regression analysis was performed, and the results showed that LVEF and MR (mild and upper) were independent risk factors of incomplete occluder endothelialization (both P<0.05). Conclusion Mild and upper MR, as well as low ejection fraction might affect normal endothelialization process after LAAO in patients with AF to some extent, leading to delayed endothelialization or incomplete endothelialization of occluder.