赵诗垚,韩国栋,陶婷,孙守刚

• 1:兰州大学第二医院(第二临床医学院)心血管内科

摘要(Abstract)：

目的 评估心脏CT血管造影（CTA）与X线透视融合技术在左心耳封堵术（LAAC中的应用。方法 本研究为前瞻性研究，纳入2022年1月至2023年8月于兰州大学第二医院行LAAC的患者82例，并根据是否接受图像融合进行1﹕1匹配。融合组（41例）为在CTA和X线透视融合技术支持下接受LAAC的患者；非融合组（41例）为在没有此技术支持的情况下接受了手术即传统手术方式的患者。记录两组的术中各项指标、围术期并发症及术后随访结局。结果 所有患者均成功封堵左心耳。融合组手术时间较非融合组明显缩短[（50.23±25.23）min比（65.71±29.15）min,P=0.012]，差异有统计学意义。融合组与非融合组比较，显著降低了总辐射剂量[（195.15±205.59）mGy比（351.08±196.54）m Gy]、剂量面积乘积[（22.47±20.05）Gy·cm~2比（38.12±19.38）Gy·cm~2]和X线透视时间[（9.03±3.58）min比（13.35±4.23）min]，与辐射剂量相对应，融合组的对比剂用量也相对减小[（59.32±24.65）ml比（93.12±35.08）ml]，差异均有统计学意义（均P<0.001）。重复经间隔穿刺率有较明显差异（2.44%比12.20%,P=0.090），但差异无统计学意义；封堵器置入成功率（100.00%比100.00%）差异无统计学意义。两组患者随访45 d及6个月手术并发症发生率的比较，差异均无统计学意义（均P>0.05）。结论 CTA和X线透视融合技术在LAAC中是可行、安全和适用的。

关键词(KeyWords)： 左心耳封堵术;CT血管造影;X线透视;图像融合

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 赵诗垚,韩国栋,陶婷,孙守刚

参考文献(References)：

• [1]Holmes DR Jr,Doshi SK,Kar S,et al.Left atrial appendage closure as an alternative to warfarin for stroke prevention in atrial fibrillation:a patient-level meta-analysis[J].J Am Coll Cardiol,2015,65(24):2614-2623.DOI:10.1016/j.jacc.2015.04.025.
• [2]袁明远,李炜,郇强,等左心耳发育不良临床及影像学分析[J].中国介入心脏病学杂志,2023,31(12):921-928.DOI:10.3969/j.issn.1004-8812.2023.12.006.
• [3]Tzikas A,Holmes DR Jr,Gafoor S,et al.Percutaneous left atrial appendage occlusion:the Munich consensus document on definitions,endpoints and data collection requirements for clinical studies[J].Euro Intervention,2016,12(1):103-111.DOI:10.4244/EIJV12I1A18.
• [4]Tzikas A,Shakir S,Gafoor S,et al.Left atrial appendage occlusion for stroke prevention in atrial fibrillation:multicentre experience with the AMPLATZER cardiac plug[J].EuroIntervention,2016,11(10):1170-1179.DOI:10.4244/EIJY15M01_06.
• [5]van Rosendael PJ,Katsanos S,van den Brink OW,et al.Geometry of left atrial appendage assessed with multidetector-row computed tomography:implications for transcatheter closure devices[J].EuroIntervention,2014,10(3):364-371.DOI:10.4244/EIJV10I3A62.
• [6]Roy AK,Horvilleur J,Cormier B,et al.Novel integrated 3D multidetector computed tomography and fluoroscopy fusion for left atrial appendage occlusion procedures[J].Catheter Cardiovasc Interv,2018,91(2):322-329.DOI:10.1002/ccd.26998.
• [7]Behnes M,Akin I,Sartorius B,et al.LAA Occluder View for post-implantation Evaluation(LOVE)--standardized imaging proposal evaluating implanted left atrial appendage occlusion devices by cardiac computed tomography[J].BMC Med Imaging,2016,16:25.DOI:10.1186/s12880-016-0127-y.
• [8]Romero J,Cao JJ,Garcia MJ,et al.Cardiac imaging for assessment of left atrial appendage stasis and thrombosis[J].Nat Rev Cardiol,2014,11(8):470-480.DOI:10.1038/nrcardio.2014.77.
• [9]Rajwani A,Nelson AJ,Shirazi MG,et al.CT sizing for left atrial appendage closure is associated with favourable outcomes for procedural safety[J].Eur Heart J Cardiovasc Imaging,2017,18(12):1361-1368.DOI:10.1093/ehjci/jew212.
• [10]Wang DD,Eng M,Kupsky D,et al.Application of 3-dimensional computed tomographic image guidance to WATCHMAN implantation and impact on early operator learning curve:single-center experience[J].JACC Cardiovasc Interv,2016,9(22):2329-2340.DOI:10.1016/j.jcin.2016.07.038.
• [11]Barreiro-Pérez M,Cruz-González I,Sánchez PL.Computed tomography-X ray fusion in left atrial appendage closure[J].Rev Esp Cardiol(Engl Ed),2017,70(10):867.DOI:10.1016/j.rec.2017.02.014.
• [12]Mo BF,Wan Y,Alimu A,et al.Image fusion of integrating fluoroscopy into 3D computed tomography in guidance of left atrial appendage closure[J].Eur Heart J Cardiovasc Imaging,2021,22(1):92-101.DOI:10.1093/ehjci/jez286.
• [13]Chen T,Liu G,Mu Y,et al.Application of cardiac computed tomographic imaging and fluoroscopy fusion for guiding left atrial appendage occlusion[J].Int J Cardiol,2021,331:289-295.DOI:10.1016/j.ijcard.2021.01.035.
• [14]Xu B,Betancor J,Sato K,et al.Computed tomography measurement of the left atrial appendage for optimal sizing of the Watchman device[J].J Cardiovasc Comput Tomogr,2018,12(1):50-55.DOI:10.1016/j.jcct.2017.11.012.
• [15]Plessis J,Warin Fresse K,Cahouch Z,et al.Value of image fusion in coronary angiography for the detection of coronary artery bypass grafts[J].J Am Heart Assoc,2016,5(6):e002233.DOI:10.1161/JAHA.115.002233.
• [16]Meier B,Blaauw Y,Khattab AA,et al.EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion[J].Europace,2014,16(10):1397-1416.DOI:10.1093/europace/euu174.
• [17]Chow DH,Bieliauskas G,Sawaya FJ,et al.A comparative study of different imaging modalities for successful percutaneous left atrial appendage closure[J].Open Heart,2017,4(2):e000627.DOI:10.1136/openhrt-2017-000627.
• [18]李佳琪,鲁静朝,靳雅琼,等.比较心脏CT血管造影与经食管超声心动图术前评估左心耳封堵术的Meta分析[J].中国介入心脏病学杂志,2023,31(12):935-945.DOI:10.3969/j.issn.1004-8812.2023.12.008.
• [19]Glassy MS,Sharma G,Singh GD,et al.Usable implantation depth for watchman left atrial appendage occlusion is greater with appendage angiography than transesophageal echocardiography[J].Catheter Cardiovasc Interv,2019,93(5):E311-E317.DOI:10.1002/ccd.27916.