Circulation:冠脉搭桥术中结扎左心耳对房颤患者短期预后的影响

2020-07-08 MedSci原创 MedSci原创

心房颤动导致的卒中,90%以上的血栓起源于左心耳,封堵左心耳是否可减少房颤患者的卒中率?

两个心房通常各有一个“耳室”,即左右心耳,从心脏正面看,这两个心房向外突出的部分很像心脏的两只耳朵,因此得名。左心耳是胚胎时期原始左心房的残余,与发育成熟的左心房不同,左心耳内有丰富的梳状肌及肌小梁,导致表面凹凸不平,易使血流在此处产生旋涡和流速减慢。左心耳通常是“口小肚子大”,使得血液容易进入却不容易流出来,因此,心房颤动导致的卒中,90%以上的血栓起源于左心耳。

本研究目的主要是评估左心耳(LAA)封堵对接受孤立性冠状动脉搭桥手术的房颤患者短期预后的影响。

研究人员调查了2010年-2014年接受冠脉搭桥联合或不联合左心耳结扎术患者的临床预后。主要评估指标是出院后30天内再次入院。次要指标是院内死亡率和卒中。

共分析了253 287例接受冠脉搭桥手术的患者,其中7.0%的患者接受了LAA封堵术。LAA排空与术后呼吸衰竭(8.2% vs 6.2%, P<0.0001)和急性肾衰竭(21.8% vs 18.5%, P<0.0001)发生风险更高相关,但与输血率和心脏压塞的发生无关。LAA排空与卒中无明显减少有关 (7.9% vs 8.6%, P=0.12),但院内死亡率无明显差异(2.2% vs 2.2% P=0.99),而且30天内再入院风险增加(16.0% vs 9.6%, P<0.0001)。经协变量校正后,LAA结扎仍是30天再入院的重要预测指标(优势比 1.640 [95% CI, 1.603–1.677], P<0.0001)。

房颤患者进行孤立性冠脉搭桥手术时排空LAA与其出院后30天内再入院风险增加有关。

原始出处:

Eitezaz Mahmood,et al. Impact of Left Atrial Appendage Exclusion on Short-Term Outcomes in Isolated Coronary Artery Bypass Graft Surgery. Circulation. 2020;142:20–28

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    2020-07-10 jxrzshh
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    2020-07-10 zzc2214
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    2020-07-10 yese
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    2020-07-08 心介

    房颤,临床上碰到很多哦

    0

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