免疫抑制薬の皮膚経由の左心房閉塞の患者への影響
Daisuke Togashi1, Christopher R Ellis1, Zachary T Yoneda1
1Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Journal of cardiovascular electrophysiology
|August 29, 2025
まとめ
免疫抑制療法 (IMS) を受けている患者にとって,皮膚経由の左心房閉塞 (LAAC) は安全です. 術後の結果は類似していますが,これらの患者は追跡期間中に,より高い全身感染率と,器具周辺の漏れの改善に直面しています.
科学分野:
- 心臓病科
- 介入心臓科
- 医療機器
背景:
- 経皮左心房閉塞 (LAAC) は,経口抗凝固剤を使用できない非弁性心房動の患者の脳卒中リスクを減らす戦略です.
- 慢性免疫抑制療法 (IMS) を受ける患者におけるLAACのアウトカムについては,十分に確立されていません.
研究 の 目的:
- 慢性 IMS を受けている患者の皮膚経由のLAACの安全性と有効性を評価する.
- IMSとIMSを受けていない患者の間での手術前と長期のアウトカムを比較する.
主な方法:
- 2017年11月から2023年3月までLAACを受けた1172人の患者の後日評価.
- 患者は,長期免疫抑制療法 (IMS) の使用に基づいて分類された.
- 分析には,手術後の合併症,臨床結果,および,手術後の漏れ (PDL) や手術後の血栓など,デバイスの追跡特性が含まれていた.
主要な成果:
- IMSとIMS以外のグループでは,手術中の合併症の有意な差は認められなかった (1. 4% 対 1. 3%).
- IMSグループでは,平均617日間の追跡期間中に全身感染症の発生率が高かった (25. 0% vs.
- 器具周辺漏れ (PDL) や器具関連の血栓の有意な差異は認められなかったが,IMS群ではPDLの改善率が低い (8. 3% vs 50. 0%).
結論:
- 経皮LAACは,慢性的なIMSを患っている患者に,手術後のリスクを増やすことなく,成功裏に実施できます.
- 長期の追跡調査は,LAAC後にIMSを投与された患者の全身感染のリスクが増加したことを明らかにした.
- IMSの使用は,時間とともに周辺装置の漏れの改善と関連しています.
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