Safety and efficacy of "one-stop" combining atrial septal defect and left atrial appendage closure

doi:10.3877/cma.j.issn.2095-6568.2023.02.004

Abstract

Abstract:

Objective

To investigate the effectiveness and safety of "one-stop" combining trial septal defect (ASD) and left atria appendage (LAA) closure(LAAC).

Methods

Patients with atrial fibrillation (AF) combined with ASD who underwent one-stop surgery for LAAC combined with ASD occlusion at Zhongshan Hospital of Fudan University from June 2018 to September 2022 were retrospectively analyzed, and demographic data such as age and gender; intraoperative imaging data such as pulmonary artery pressure, LAA pressure, and ASD size of atrial septal defect were collected.And left atrial septal defect was followed up at 6 and 12 months after surgery echocardiographic information such as left atrial internal diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), degree of tricuspid regurgitation (TR) and electrocardiogram (ECG) information were followed up at 6 months and 12 months after surgery. Postoperative complications such as blocker thrombosis, residual shunt at blocker, blocker malfunction, pericardial effusion and new arrhythmias were recorded.

Results

A total of 32 patients [(68.2±9.3) years ], including 11 males (34.3%,11/32) were included in this study, and all patients successfully underwent a combined "one-stop" procedure for LAAC and ASD occlusion. Intraoperatively, the blocker was properly positioned and well fixed, and no complications such as residual shunt were found. One patient was found to have a minor residual shunt, and one patient developed novel right bundle branch block at the 6-month postoperative follow-up, but no adverse events were found at the 12-month postoperative follow-up.

Conclusion

The combined "one-stop" procedure of LAA and ASD occlusion is safe and effective for patients with ASD combined with AF, with satisfactory follow-up results.

Key words: Atrial septal defect, Atrial fibrillation, Left atrial appendage closure, One-stop

Jianing Fan, Dawei Lin, Mingfei Li, Feng Zhang, Xiaochun Zhang, Wenzhi Pan, Daxin Zhou. Safety and efficacy of "one-stop" combining atrial septal defect and left atrial appendage closure[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(02): 109-113.

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Figures/Tables 5

项目	数值
年龄（岁， $x ¯ ± s$ ）	68.2±9.3
男［例（%）］	11（34.3）
BMI（kg/㎡， $x ¯ ± s$ ）	22.2±3.6
心房颤动类型［例（%）］
持续性	29（90.6）
阵发性	3（9.4）
高血压［例（%）］	10（31.2）
糖尿病［例（%）］	2（6.2）
卒中史［例（%）］	3（9.4）
CHA₂DS₂-VASc评分（分， $x ¯ ± s$ ）	2.7±1.6
HAS-BLED评分（分， $x ¯ ± s$ ）	2.1±1.1
心功能（NYHA分级）≥Ⅱ级［例（%）］	5（22.3）

项目	数值
年龄（岁， $x ¯ ± s$ ）	68.2±9.3
男［例（%）］	11（34.3）
BMI（kg/㎡， $x ¯ ± s$ ）	22.2±3.6
心房颤动类型［例（%）］
持续性	29（90.6）
阵发性	3（9.4）
高血压［例（%）］	10（31.2）
糖尿病［例（%）］	2（6.2）
卒中史［例（%）］	3（9.4）
CHA₂DS₂-VASc评分（分， $x ¯ ± s$ ）	2.7±1.6
HAS-BLED评分（分， $x ¯ ± s$ ）	2.1±1.1
心功能（NYHA分级）≥Ⅱ级［例（%）］	5（22.3）

项目	参数
超声心动图
LAA汇总宽度（mm）	23.1±2.7
LAA汇总深度（mm）	25.4±4.1
右心导管
LAA宽度（mm）	26.7±3.8
LAA深度（mm）	27.9±3.9
PA收缩压（mmHg）	37.4±10.4
PA平均压（mmHg）	20.7±6.9
PA舒张压（mmHg）	12.0±9.6
RV平均压（mmHg）	6.6±3.7
RA平均压（mmHg）	6.2±4.1
LAA平均压（mmHg）	8.0±3.8
LAA封堵器大小（mm）	31.3±4.2
ASD大小（mm）	19.1±7.3
ASD封堵器大小（mm）	25.5±8.5
残余分流［例（%）］	1（3.1）

超声心动图指标	术前	术后6个月	术后12个月
LAD（mm）	46.3±5.8	44.1±4.5（P₁=0.191）	44.0±6.4（P₂=0.847）
LVESD（mm）	26.5±3.5	28.8±2.9（P₁=0.107）	27.9±4.5（P₂=0.533）
LVEDD（mm）	41.5±4.9	43.2±3.5（P₁=0.139）	43.4±4.1（P₂=0.704）
LVEF（%）	65.2±5.9	64.5±4.6（P₁=0.660）	64.6±3.9（P₂=0.826）
RAD（mm）	56.6±7.9	49.4±8.4（P₁=0.017）	49.2±8.1（P₂=0.483）
RVD（mm）	46.7±9.8	40.1±8.9（P₁=0.032）	40.5±8.6（P₂=0.801）
PASP（mmHg）	46.3±10.4	43.2±7.3（P₁=0.027）	44.5±6.3（P₂=0.642）
中重度TR［例（%）］	30（93.8）	8（25.0）（P₁＜0.001）	6（18.8）（P₂=0.518）

项目	6个月	12个月
封堵器表面血栓形成	0	0
残余分流	1	0
封堵器故障（穿孔、断裂）	0	0
心包积液	0	0
术后新发心律失常
偶发早搏	0	0
房室传导阻滞	0	0
右束支传导阻滞	1	0

References 15

[1]	Hoffman JI, Kaplan S. The incidence of congenital heart disease[J]. J Am Coll Cardiol, 2002, 39(12):1890-1900.
[2]	Lindsey JB, Hillis LD. Clinical update: atrial septal defect in adults[J]. Lancet, 2007, 369(9569):1244-1246.
[3]	Kosturakis R, Price MJ. Current state of left atrial appendage closure[J]. Curr Cardiol Rep, 2018, 20(6):42.
[4]	Gasperetti A, Fassini G, Tundo F, et al. A left atrial appendage closure combined procedure review: Past, present, and future perspectives[J]. J Cardiovasc Electrophysiol, 2019, 30(8):1345-1351.
[5]	Chiu SN, Wu MH, Tsai CT, et al. Atrial flutter/fibrillation in patients receiving transcatheter closure of atrial septal defect[J]. J Formos Med Assoc, 2017, 116(7):522-528.
[6]	姜小飞, 曾杰, 卢聪, 等. 左心耳封堵联合房间隔缺损封堵"一站式"治疗对房间隔缺损合并心房颤动患者的安全性及疗效观察[J]. 中国心血管病研究, 2020, 18(1):10-14.
[7]	Nattel S. Molecular and cellular mechanisms of atrial fibrosis in atrial fibrillation[J]. JACC Clin Electrophysiol, 2017, 3(5):425-435.
[8]	Mandalenakis Z, Rosengren A, Lappas G, et al. Atrial fibrillation burden in young patients with congenital heart disease[J]. Circulation, 2018, 137(9):928-937.
[9]	Sohns C, Marrouche NF. Atrial fibrillation and cardiac fibrosis[J]. Eur Heart J, 2020, 41(10):1123-1131.
[10]	Li CY, Zhang JR, Hu WN, et al. Atrial fibrosis underlying atrial fibrillation (Review)[J]. Int J Mol Med, 2021, 47(3):9.
[11]	Webb G, Gatzoulis MA. Atrial septal defects in the adult: recent progress and overview[J]. Circulation, 2006, 114(15):1645-1653.
[12]	Zhang ZH, Yao Q, Huang HY, et al. "One-stop shop": safety and efficacy of combining atrial septal defect occlusion and left atrial appendage closure for patients with atrial septal defect and atrial fibrillation[J]. BMC Cardiovasc Disord, 2020, 20(1):444.
[13]	崔春生, 王建铭, 朱鲜阳, 等. 左心耳封堵术治疗先天性心脏病合并房颤临床观察[J]. 临床军医杂志, 2016, 44(10):1087-1089,1091.
[14]	Nyboe C, Olsen MS, Nielsen-Kudsk JE, et al. Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure[J]. Heart, 2015, 101(9):706-711.
[15]	Attie F. Atrial septal defect in patients over 40 years-old[J]. Rev Esp Cardiol, 2002, 55 (Suppl 1):33-36.

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