背景:AmplatzerAmulet是用于左心耳闭塞(LAAO)的常用装置。当前的尺寸设定方案基于左心耳(LAA)着陆区的最大直径。然而,意思是,周界-,或面积推导的直径可能是更准确的设备尺寸测量。
方法:回顾性分析150例接受LAAO的连续患者在术前心脏CT引导下进行。共纳入117例患者;7例因肾衰竭而被排除,26例因三明治技术闭合而被排除。最大,意思是,面积-,着陆区的周边直径来自手术前的心脏CT扫描,并研究了它们预测植入设备尺寸的准确性。基于当前推荐的大小调整算法来确定预测的设备大小。评估了装置周围泄漏(PDL)(1-3级)以及潜在机制。
结果:设备尺寸精度优于平均值,面积-,以及与最大直径相比的周长推导直径,特别是偏心着陆区。预测和实际植入装置尺寸之间的平均差为0.08mm(±2.77),0.30mm(±2.40),-0.39mm(±2.43),和-2.55mm(±2.57)的平均值,面积派生,周边派生,和最大直径,分别。在8.5%的植入物中发现了3级周围装置泄漏,与着陆区的偏心度没有显着关联。PDL的主要机制是设备对准不良。
结论:我们的结果表明,面积-,和器件着陆区的周边衍生直径,与最大直径相比,器件尺寸精度相似且优越。
BACKGROUND: Amplatzer Amulet is a frequently used device for left atrial appendage occlusion (LAAO). The current sizing protocol is based on the maximum diameter of the left atrial appendage (LAA) landing zone. However, mean, perimeter-, or area-derived diameter might be more accurate measures for device sizing.
METHODS: Retrospective analysis of 150 consecutive patients undergoing LAAO is guided by pre-procedural cardiac CT. A total of 117 patients were included; 7 were excluded due to renal failure and 26 due to closure with the sandwich technique. The maximum, mean, area-, and perimeter-derived diameters of the landing zone were derived from pre-procedural cardiac CT scans, and their accuracy to predict the implanted device size was investigated. The predicted device size was determined based on the currently recommended sizing algorithm. Peri-device leak (PDL) was assessed (grade 1-3) along with the underlying mechanism.
RESULTS: Device-sizing accuracy was superior for mean, area-, and perimeter derived diameters compared with the maximal diameter, especially for eccentric landing zones. Mean difference between predicted and actually implanted device size was 0.08 mm (± 2.77), 0.30 mm (± 2.40), - 0.39 mm (± 2.43), and - 2.55 mm (± 2.57) across mean, area-derived, perimeter-derived, and maximal diameter, respectively. Grade 3 peri-device leak was seen in 8.5% of implants without a significant association to the eccentricity of the landing zone. The leading mechanism for PDL was device malalignment.
CONCLUSIONS: Our results indicate mean, area-, and perimeter-derived diameters of the device landing zone to perform similar and superior in device-sizing accuracy compared with the maximum diameter.