Aashish Katapadi, Jalaj Garg, Aditya Mansabdar, Nikhila Chelikam, Fnu Ehteshamuddin, Minar Rane, Devi Nair, James Marcum, Theodore Pope, Peter Park, Christopher Ellis, Rajesh Kabra, Monica Lo, Donita Atkins, Jacqueline Saw, Atman Shah, Dhanunjaya Lakkireddy
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Pulmonary artery injury (PAI) is a feared yet rare complication of endocardial LAAC, but its surrounding literature is scarce.</p><p><strong>Objectives: </strong>The aim of the current study was to review prior PAI published reports and the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to understand evidence and mechanisms of PAI after LAAC.</p><p><strong>Methods: </strong>A systematic review was conducted of the literature and MAUDE database for previously reported cases of PAI, and cases were reviewed for patient characteristics and outcomes. In addition, we identify risks and review our strategies to avoid this injury.</p><p><strong>Results: </strong>Thirty-six cases (16 case reports and 20 MAUDE reports) of PAI were found. These patients had a mean age of 73.6 ± 8.2 years with a median CHA<sub>2</sub>DS<sub>2</sub>VASC score of 5 (quartile 1-quartile 3: 3-6). Most commonly, LAAC associated with PAI involved a dual-seal (75%) followed by lobular occlusive devices (19.4%); the device was unspecified in 2.8% of cases. PAI commonly presented postprocedurally, either within the first 24 hours (50%) or beyond (38.9%), with cardiac tamponade (61.1%) or cardiac arrest (19.4%). Overall, 52.8% required surgery with or without antecedent pericardiocentesis, and 16.7% were managed with pericardiocentesis. PAI was associated with a high mortality rate (ie, 33.3%). Unfortunately, no specific cardiac imaging or procedural details to predict PAI were noted in the reports.</p><p><strong>Conclusions: </strong>Presentation of PAI after LAAC can occur immediately following the procedure or be delayed. Thus, the threshold for suspicion, especially with rapid and hemodynamically significant pericardial effusion, after LAAC should be low.</p>","PeriodicalId":14573,"journal":{"name":"JACC. 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Most commonly, LAAC associated with PAI involved a dual-seal (75%) followed by lobular occlusive devices (19.4%); the device was unspecified in 2.8% of cases. PAI commonly presented postprocedurally, either within the first 24 hours (50%) or beyond (38.9%), with cardiac tamponade (61.1%) or cardiac arrest (19.4%). Overall, 52.8% required surgery with or without antecedent pericardiocentesis, and 16.7% were managed with pericardiocentesis. PAI was associated with a high mortality rate (ie, 33.3%). Unfortunately, no specific cardiac imaging or procedural details to predict PAI were noted in the reports.</p><p><strong>Conclusions: </strong>Presentation of PAI after LAAC can occur immediately following the procedure or be delayed. Thus, the threshold for suspicion, especially with rapid and hemodynamically significant pericardial effusion, after LAAC should be low.</p>\",\"PeriodicalId\":14573,\"journal\":{\"name\":\"JACC. 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引用次数: 0
摘要
背景:左心房阑尾关闭术(LAAC)是口服抗凝禁忌症患者预防中风的常用替代方法。肺动脉损伤(PAI)是心内膜 LAAC 令人担忧但却罕见的并发症,但相关文献却很少:本研究旨在回顾之前发表的 PAI 报告和美国食品药品管理局制造商和用户设施设备经验(MAUDE)数据库,以了解 LAAC 后 PAI 的证据和机制:方法:我们对文献和 MAUDE 数据库中之前报道的 PAI 病例进行了系统性回顾,并对病例的患者特征和结果进行了回顾。此外,我们还确定了风险并回顾了避免这种损伤的策略:结果:共发现 36 例 PAI(16 例病例报告和 20 例 MAUDE 报告)。这些患者的平均年龄为 73.6 ± 8.2 岁,中位 CHA2DS2VASC 评分为 5(1-3 分位:3-6)。与 PAI 相关的 LAAC 最常见的是双密封(75%),其次是小叶闭塞器(19.4%);2.8% 的病例未指定闭塞器。PAI 通常在手术后 24 小时内(50%)或 24 小时后(38.9%)出现,伴有心脏填塞(61.1%)或心脏骤停(19.4%)。总体而言,52.8%的患者需要在进行或不进行心包穿刺的情况下进行手术,16.7%的患者在进行心包穿刺后得到了控制。PAI 与高死亡率有关(即 33.3%)。遗憾的是,报告中没有提到预测 PAI 的具体心脏成像或手术细节:结论:LAAC 术后 PAI 可在术后立即出现,也可延迟出现。结论:LAAC 术后 PAI 可在术后立即出现,也可延迟出现。因此,LAAC 术后的怀疑阈值应较低,尤其是快速且血流动力学显著的心包积液。
Pulmonary Artery Injury Following Endocardial Left Atrial Appendage Occlusion: The Known and Unknown.
Background: Left atrial appendage closure (LAAC) is frequent alternative for stroke prophylaxis in patients for whom oral anticoagulation is contraindicated. Pulmonary artery injury (PAI) is a feared yet rare complication of endocardial LAAC, but its surrounding literature is scarce.
Objectives: The aim of the current study was to review prior PAI published reports and the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to understand evidence and mechanisms of PAI after LAAC.
Methods: A systematic review was conducted of the literature and MAUDE database for previously reported cases of PAI, and cases were reviewed for patient characteristics and outcomes. In addition, we identify risks and review our strategies to avoid this injury.
Results: Thirty-six cases (16 case reports and 20 MAUDE reports) of PAI were found. These patients had a mean age of 73.6 ± 8.2 years with a median CHA2DS2VASC score of 5 (quartile 1-quartile 3: 3-6). Most commonly, LAAC associated with PAI involved a dual-seal (75%) followed by lobular occlusive devices (19.4%); the device was unspecified in 2.8% of cases. PAI commonly presented postprocedurally, either within the first 24 hours (50%) or beyond (38.9%), with cardiac tamponade (61.1%) or cardiac arrest (19.4%). Overall, 52.8% required surgery with or without antecedent pericardiocentesis, and 16.7% were managed with pericardiocentesis. PAI was associated with a high mortality rate (ie, 33.3%). Unfortunately, no specific cardiac imaging or procedural details to predict PAI were noted in the reports.
Conclusions: Presentation of PAI after LAAC can occur immediately following the procedure or be delayed. Thus, the threshold for suspicion, especially with rapid and hemodynamically significant pericardial effusion, after LAAC should be low.
期刊介绍:
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.