JACC:左心耳封堵术后急性肾损伤的发病率、预测因子和预后价值

2018-06-11 xiangting MedSci原创

LAAC后AKI的发生相对频繁,肾小球滤过率较低的患者出现这种并发症的风险较高。

这项研究旨在确定左心耳封堵术(LAAC)后围手术期急性肾损伤(AKI)的发病率、预测因子和预后价值。目前没有关于LAAC后AKI发生的数据。

共纳入355例接受LAAC的患者。AKI定义为住院期间术后血肌酐绝对值或相对值分别升高>0.3mg/dl或≥50%,或者需要血透。

AKI发病率为9%,基线肾功能差的患者发生AKI的风险较高(肾小球滤过率每降低10ml/min,比值比:1.32; 95%可信区间[CI]:1.09至1.61; p=0.004)。AKI组的院内出血事件发生率更高(5.3%vs. 15.6%; p=0.037)。中位随访18个月后,AKI组患者的死亡率更高(风险比[HR]:2.59; 95%CI:1.36-4.92; p=0.004),栓塞事件(HR:6.14; 95 %CI:2.23至16.92; p=0.001)和主要出血事件更多(HR:2.36; 95%CI:0.89至6.24; p=0.083)。出现AKI是中期死亡率的独立预测因子(HR:2.00; 95%CI:1.02至3.91; p=0.044)。

LAAC后AKI的发生相对频繁,肾小球滤过率较低的患者出现这种并发症的风险较高。AKI确定了一组中期预后较差的患者,强调了对该人群制定进一步预防策略的重要性。

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    2019-03-04 ycmayy
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    2019-02-19 hbwxf
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  5. 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  6. 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  7. 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    2018-06-13 jxrzshh
  10. 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    2018-06-11 1ddf0692m34(暂无匿称)

    学习了.长知识

    0

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Circulation:左心耳封堵术后装置相关性血栓:发病率、预测因子和结局

使用Watchman的LAAC后,DRT(~3.7%)并不常见,但一旦发生DRT,则与中风和全身性栓塞的发病率较高相关。

JACC:这种治疗房颤的昂贵手术,真的值得推荐吗?

近期,JACC发表的一项新的研究数据表明,对于接受左心耳封堵术的房颤患者,术后器械相关血栓年发生率高达7.2%,并会进一步增加卒中风险。

西安交大一附西北地区率先实施左心耳与房间隔缺损联合封堵手术

西安交大一附院心血管病医院张玉顺教授团队近日成功完成一例心房颤动合并房间隔缺损患者的左心耳与房间隔缺损联合封堵手术。目前患者已康复出院。该患者有多年房颤病史,同时合并高龄女性、高血压病、短暂性脑缺血发作、肝功能异常等多重危险因素,近期病情加重,危及生命。在充分权衡患者血栓栓塞风险与服用抗凝药物的出血风险后,张玉顺教授与患者及家属充分交流后决定实施左心耳封堵手术,降低栓塞风险的同时也避免出血风险增加

Circ:Cardiovasc Inte:经皮左心耳封闭术是脑血管病高危房颤患者的合理选择

LAA封闭主要用于合并症多且预后差的患者。这类患者进行LAA封闭似乎可以合理降低卒中发生率。

JACC:左心房心腔内超声心动图对经导管左心耳封堵术的手术引导

与TEE相比,LA ICE引导LAAO更为安全有效,没有增加手术相关并发症。