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首页> 外文期刊>The Egyptian Heart Journal >Safety and efficacy of transcatheter left atrial appendage closure using the Watchman device in Egyptian patients with nonvalvular atrial fibrillation
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Safety and efficacy of transcatheter left atrial appendage closure using the Watchman device in Egyptian patients with nonvalvular atrial fibrillation

机译：使用Watchman装置经导管左心耳封堵在埃及非瓣膜性房颤患者中的安全性和有效性

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Background Atrial fibrillation (AF) is considered the major cause of stroke in the elderly. Alternative therapies to the anticoagulant therapy are warranted, particularly in patients who are ineligible or at high risk of bleeding. The left atrial appendage (LAA) is a prominent source of thrombi in nonvalvular AF, accounting for 90% of thrombi. As a result, surgical and transcatheter techniques have been explored to reduce the risk of stroke in patients with AF by occluding the LAA. Objectives To assess the safety and efficacy of LAA closure in patients with nonvalvular atrial fibrillation (AF) ineligible for warfarin therapy. Methods A prospective study that evaluated LAA closure with the Watchman device (Boston Scientific, Natick, MA; group A) in fifteen patients with nonvalvular AF and CHADS2 (congestive heart failure, hypertension, age ?75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score ?1, who were considered ineligible for warfarin therapy. The primary efficacy endpoint was the combined events of ischemic/hemorrhagic stroke, systemic embolism and cardiovascular/unexplained death during a period of six months follow-up. Results Successful closure of the LAA using the Watchman device was achieved in 15 patients (100%). The mean age was found to be 67.9 ± 9 years with 40% of them being males. No device or procedure related adverse events were detected. The mean CHADS2 score was 2.4 ± 0.8, while the mean CHA2DS2-VASC score was 4.4 ± 1.0. After a mean period of 8 ± 2 months of follow-up, no device dislodgement or device-related thrombi were documented. The all-cause stroke (ischemic and hemorrhagic) and systemic embolism were 0%. The device and procedure related mortality was found to be 0%. Only one patient died after 8 months of device implantation from pneumonia. Conclusion LAA closure with the Watchman device can be safely performed, and may be a reasonable alternative to consider for patients at high risk for stroke but with contraindications to systemic oral anticoagulation or with high risk of bleeding.
机译：背景心房颤动（AF）被认为是老年人中风的主要原因。必须使用抗凝疗法的替代疗法，特别是对于不合格或有高出血风险的患者。左心耳（LAA）是非瓣膜性房颤的主要血栓来源，占血栓的90％。结果，已经探索了外科手术和经导管技术以通过闭塞LAA来降低AF患者中风的风险。目的评估不适合使用华法林治疗的非瓣膜性房颤（AF）患者的LAA封堵的安全性和有效性。方法对15例非瓣膜性房颤和CHADS2患者（充血性心力衰竭，高血压，年龄≥75岁，糖尿病，先前卒中或非卒中）使用Watchman装置（波士顿科学公司，内蒂克，马萨诸塞州; A组）评估LAA封闭的前瞻性研究。短暂性脑缺血发作）评分≤1，被认为不适合使用华法林治疗。主要疗效终点是六个月的随访期间缺血性/出血性中风，全身性栓塞和心血管性/原因不明的死亡的综合事件。结果15例患者（100％）使用Watchman设备成功关闭了LAA。发现平均年龄为67.9±9岁，其中40％为男性。未检测到与设备或程序相关的不良事件。 CHADS2平均得分为2.4±0.8，而CHA2DS2-VASC平均得分为4.4±1.0。在平均随访8±2个月之后，没有记录到器械移位或与器械相关的血栓。全因卒中（缺血性和出血性）和全身性栓塞为0％。发现与设备和手术相关的死亡率为0％。在植入设备8个月后因肺炎死亡。结论用Watchman装置进行LAA封闭可以安全地进行，对于中风高危但全身性口服抗凝禁忌症或高出血风险的患者，可以考虑采用合理的替代方法。

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