数字减影血管造影指导下极简式经皮左心耳封堵术治疗非瓣膜病心房颤动35例

目的 探讨无全身麻醉、无经食管超声心动图(TEE)的在数字减影血管造影(DSA)指导下极简式经皮左心耳封堵术(PLAAO)治疗非瓣膜病心房颤动的可行性及安全性.方法 选取2019年9月至2020年12月安徽医科大学第二附属医院收治的具有手术指征的非瓣膜病心房颤动病人35例,术中左心耳造影替代TEE、局部麻醉下进行PLA...

Nonvalvular atrial fibrillation in percutaneous left atrial appendage occlusion guided by DSA: 35 cases

Objective To investigate the feasibility and safety of percutaneous left atrial appendage closure (PLAAO) guided by dig?ital subtraction angiography (DSA) without general anesthesia and transesophageal echocardiography (TEE).Methods Thirty-five pa?tients with non-valvular atrial fibrillation who met the surgical criteria in the Second Affiliated Hospital of Anhui Medical University from September 2019 to December 2020 were selected. Intraoperative left atrial appendage angiography replaced TEE and PLAAO was performed under local anesthesia. TEE was reexamined at 45 days and 6 months after operation to observe the main adverse events re?lated to PLAAO.Results Intraoperative device operation was successful in 32 patients, 1 patient had no appropriate size occluder due to too large left atrial appendage opening, 1 patient could not be adjusted to the releasable position due to poor catheter coaxiality, and1 patient had low intraoperative blood pressure which is difficult to correct and could not complete the operation. One patient had sub?clavian puncture site hematoma, no serious complications related to occlusion were found in the other patients, and no major adverse events related to PLAAO occurred during hospitalization and follow-up. The operation time and fluoroscopy time were (50.27±24.60)min and (11.09±5.72) min.The hospital stay was (4.25±1.36) days, and the operation cost (excluding anesthesia and occluder cost) of PLAAO patients under minimalist local anesthesia in this group were (19 648.04±1 838.45) yuan, respectively.Conclusions Minimal?ist PLAAO under the guidance of DSA is safe and effective in the treatment of non-valvular atrial fibrillation. This method simplifies the surgical process, reduces the cost of surgery, reduces the length of hospital stay, reduces adverse reactions, which is conducive to the normalization and promotion of PLAAO operation.