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在隔离的冠状动脉旁路移植中,左心房附属体封闭的采用越来越多

Alexander A Brescia¹, Jordan D Groskurth², Edward T Murphy²

¹Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.

The Annals of thoracic surgery

|June 1, 2024

概括

一项质量倡议成功增加了心脏手术中心房动患者的左心房尾闭塞 (LAAO) 使用. 这种程序没有增加操作风险,但作为质量指标显示出有前途.

科学领域:

心血管外科心血管外科
改善医疗质量改善医疗质量
干预心脏病学干预心脏病学

背景情况:

随机试验表明,心脏动患者心脏手术后的左心室尾闭塞 (LAAO) 降低了中风风险.
这项研究的重点是制定质量倡议,以提高LAAO采用率.

研究的目的:

实施和评估一项全州范围的质量改进计划,旨在增加符合条件的心脏手术患者的左心室尾闭塞 (LAAO) 的采用率.
评估质量倡议对LAAO利用率和患者结果的影响.

主要方法:

一项涉及33家医院的全州合作,针对那些接受隔离冠状动脉旁路移植 (CABG) 且心房动的患者.
一个中断的时间序列分析比较了质量倡议实施前 (2019年1月至2019年12月) 和之后 (2021年1月至3月) 的LAAO率.
患者特征,程序数据和临床结果在接受和不接受同时接受LAAO的患者之间进行了比较.

主要成果:

在倡议后,LAAO的比例从61%大幅增加到79% (P < .001).
接受LAAO的患者年龄较大,而且更常见的是男性,具有类似的CHA2DS2-VASc得分,但与没有LAAO的患者相比,预测死亡风险较低.
同时服用LAAO增加了最小的手术时间,并没有增加手术死亡率,重大发病率或血栓塞栓事件.

结论:

左心室尾阻塞 (LAAO) 可以安全地与隔离冠状动脉旁路移植 (CABG) 一起进行,而不会增加手术风险.
全州范围内的质量改善计划有效地提高了CABG接受心房动患者同时发生LAAO的发生率.
这些发现支持对LAAO作为心脏手术中的潜在质量指标的评估.

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