关闭左心房附壁对窦性心律患者二尖瓣修复术后血栓栓塞率无影响

IF 2.6 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Maria Ascaso MD, Carolyn M. David BN, Chun-Po Steve Fan PhD, Sudipta Saha PhD, Tirone E. David MD
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引用次数: 0

摘要

关闭左心房附壁(LAA)可降低心房颤动(AF)患者的 TIA/中风发生率,但其在因瓣叶脱垂而接受二尖瓣修复术(MV)的窦性心律患者中的作用尚不清楚。本研究探讨了在二尖瓣修复术后关闭 LAA 对 TIA/中风的影响。我们对 2000 年至 2019 年期间因瓣叶脱垂接受二尖瓣修复术的患者数据库进行了回顾。在排除了 TIA/中风风险较高的患者后,1050 名窦性心律的患者被纳入研究:其中 781 人患有开放性 LAA,269 人患有手术封闭性 LAA。通过倾向评分分析来弥补临床差异,267 对开放性和闭合性 LAA 患者进行了配对。由于近几年才开始常规关闭 LAA,因此随访时间以 5 年为限。整个队列中 5 年的 TIA/ 卒中累积发生率为 2.7% [95% CI 1.9, 4.0];开放式 LAA 患者为 2.9% [95% CI 1.9, 4.4],封闭式 LAA 患者为 1.8% [95% CI 0.7, 4.9](P = 0.53)。在配对队列中,TIA/卒中的累积发病率没有显著差异(配对调整 HR [95% CI] = 0.80 [0.21, 2.98],P = 0.74),多变量 Cox 比例危险回归分析也证实两组之间的 TIA/ 卒中风险没有差异(回归调整 HR [95% CI] = 0.58 [0.12, 2.9],P = 0.47)。该研究未能显示窦性心律患者关闭 LAA 可降低 TIA/卒中风险(图 6)。在中风修复过程中关闭 LAA 需要进行更大规模、更严格的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Closure of Left Atrial Appendage Has no Effect on Thromboembolic Rates after Mitral Valve Repair in Patients in Sinus Rhythm

Closure of Left Atrial Appendage Has no Effect on Thromboembolic Rates after Mitral Valve Repair in Patients in Sinus Rhythm

Closure of Left Atrial Appendage Has no Effect on Thromboembolic Rates after Mitral Valve Repair in Patients in Sinus Rhythm

Closure of the left atrial appendage (LAA) reduces the rates of TIA/stroke in patients in atrial fibrillation (AF) but its role in patients in sinus rhythm who undergo mitral valve repair (MV) for leaflet prolapse remains unknown. This study examined the effects of closing the LAA in TIA/stroke after MV repair. Our database on patients who had MV repair for leaflet prolapse from 2000 through 2019 was reviewed. After excluding patients at higher risk of TIA/stroke, 1050 patients in sinus rhythm were entered into the study: 781 with open LAA and 269 with surgically closed LAA. Using a propensity score analysis to compensate from clinical differences, 267 pairs of patients with open and closed LAA were matched. Follow-up was truncated at 5 years because routine closure of the LAA was performed only during recent years. The cumulative incidence of TIA/stroke at 5 years in the entire cohort was 2.7% [95% CI 1.9, 4.0]; it was 2.9% [95% CI 1.9, 4.4] in patients with open LAA,and 1.8% [95% CI 0.7, 4.9] in patients with closed LAA (P = 0.53). In the matched cohorts, the cumulative incidences of TIA/stroke did not differ significantly (match-adjusted HR [95% CI] = 0.80 [0.21, 2.98], P = 0.74), and multivariable Cox proportional hazard regression analysis also confirmed no difference in the risk of TIA/stroke between the 2 groups (regression-adjusted HR [95% CI] = 0.58 [0.12, 2.9], P = 0.47). This study failed to show a reduction in the risk of TIA/stroke by closing the LAA in patients in sinus rhythm (Figure 6). Closure of the LAA during MV repair warrants a larger and more rigorous study.

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来源期刊
Seminars in Thoracic and Cardiovascular Surgery
Seminars in Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine
CiteScore
5.80
自引率
0.00%
发文量
324
审稿时长
12 days
期刊介绍: Seminars in Thoracic and Cardiovascular Surgery is devoted to providing a forum for cardiothoracic surgeons to disseminate and discuss important new information and to gain insight into unresolved areas of question in the specialty. Each issue presents readers with a selection of original peer-reviewed articles accompanied by editorial commentary from specialists in the field. In addition, readers are offered valuable invited articles: State of Views editorials and Current Readings highlighting the latest contributions on central or controversial issues. Another prized feature is expert roundtable discussions in which experts debate critical questions for cardiothoracic treatment and care. Seminars is an invitation-only publication that receives original submissions transferred ONLY from its sister publication, The Journal of Thoracic and Cardiovascular Surgery. As we continue to expand the reach of the Journal, we will explore the possibility of accepting unsolicited manuscripts in the future.
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