Application of Transesophageal Echocardiography Assisted Thoracoscopic Left Atrial Appendage Clipping in Atrial Fibrillation Patients With High Risk of Stroke and Bleeding
10.3969/j.issn.1009-6604.2024.06.006
- VernacularTitle:食道超声心动图辅助胸腔镜左心耳夹闭术在高栓塞和高出血风险心房颤动患者中的应用
- Author:
Shengzhong LIU
1
;
Dachuang WEI
;
Bo XIANG
;
Jin TAN
;
Wenhua LI
;
Keli HUANG
Author Information
1. 四川省医学科学院·四川省人民医院 电子科技大学附属医院心脏大血管外科,成都 610072
- Keywords:
Left atrial appendage clipping;
Thoracoscopic surgery;
Transesophageal echocardiography;
Atrial fibrillation;
Stroke;
High bleeding risk
- From:
Chinese Journal of Minimally Invasive Surgery
2024;24(6):432-437
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the safety and efficacy of transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping in atrial fibrillation patients with high risk of stroke and bleeding.Methods Clinical data of 14 atrial fibrillation patients with high risk of stroke and bleeding from November 2021 to May 2023 was retrospectively analyzed.All the patients had suffered from cerebral infarction.The CHA2DS2-VASc score was 3-7(mean,5.0±1.4)and the HAS-BLED score was 3-4(mean,3.3±0.5).The thoracoscopic surgery was performed with two ports.The left atrial appendage clipping was performed by using a domestically produced E-Clip left atrial appendage closure system,assisted by transesophageal echocardiography.Results All the operations were successfully performed.The mean operation time was(39.6±7.7)min,the mean drainage volume after operation was(80.4±37.1)ml,and the drainage tube was removed at(26.0±2.5)h after operation.All the 14 patients were followed up for 3-21 months,with a median of 8 months.Complete closure of the left atrial appendage without residual leakage and no thrombosis in the left atrium were confirmed by transthoracic echocardiography.No new cerebral infarction or bleeding lesions in the brain was detected by CT scanning.The electrocardiogram showed that 2 patients converted to sinus rhythm and 12 patients still maintained atrial fibrillation rhythm.Conclusions Transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping can completely closure left atrial appendage and avoid new onset of stroke in atrial fibrillation patients with high risk of stroke and bleeding.It can also play a role in electrical isolation of left atrial appendage so as to cure atrial fibrillation in few patients.
