| Background and objectives:Atrial fibrillation(AF)is a common arrhythmia in clinical practice.Stroke is one of the main causes of disability and mortality in patients with atrial fibrillation.Compared with stroke unrelated to AF,stroke related to AF has higher morbidity and disability rate and leads to greater medical expenditure.Stroke prevention is an important part of atrial fibrillation management,Traditional prevention strategies include oral vitamin K antagonists or new oral anticoagulants.However,due to their own pharmacological characteristics,their clinical application is limited,Therefore,non-drug therapy for stroke prevention in AF patients seems reasonable and urgently needed.PREVAIL study and PROTECT study confirmed that the LAAO is no less than warfarin in preventing thromboembolism,thus confirming the position of the left atrial appendage occlusion in AF thromboembolism.Although ablation is believed to be effective in controlling rhythm and improving patient symptoms,its role in stroke prevention has not been confirmed.LAAO has become a hot topic in non-drug antithrombotic strategy research for stroke high-risk groups of NVAF patients,and has been proved to be a safe and effective method to prevent AF-related cerebrovascular events.On the basis of affirming the effective substitution of percutaneous LAAC for anticoagulant therapy,some people have proposed a combined strategy of CA to relieve AF symptoms and LAAO to prevent stroke,referred to as "one-stop surgical treatment",and evaluated its effectiveness and safety.Based on the above background,this topic is based on CA combined with LAAO of atrial fibrillation.It is intended to discuss the effectiveness and safety of the operation,perioperative and postoperative complications,the anti-thrombus treatment plan after the operation,and the advantages and disadvantages of the combined operation.Methods:123 patients with NVAF who underwent one-stop surgical treatment in the department of cardiology of our hospital were selected according to strict inclusion criteria and exclusion criteria,and one-stop operation was performed under general anesthesia.Perioperative and postoperative complications were observed and recorded to evaluate the safety and effectiveness of the operation.Postoperative complications,cardiac structure and function,and postoperative anticoagulation plan were regularly followed up and recorded.Results:A total of 123 patients completed one-stop surgical treatment,all patients met the criteria for successful sealing of the LAA.Periprocedural complications mainly included include cardiac tamponade(3.30%)and thrombosis of occluder(0.81%).The structure of the left atrium did not change significantly before and after the operation(P>0.05)5 but the ejection fraction of the patient increased significantly(55.92 vs 60.53,P<0.05).After a mean follow-up of 9 months,there were death(0.90%),stroke(2.70%),cerebral hemorrhage(1.80%),device related thrombus(2.70%),vascular injury(0.90%),AF recurrence(12.70%)and other clinical events.Statistical analysis showed that there was no significant correlation between the occurrence of postoperative complications and postoperative anticoagulant regimen.Conclusion:Single operation combined with LAAO and CA is safe and feasible,and can be used as an alternative therapy for AF patients with drug refractory,high stroke risk,high bleeding risk and relative or absolute contraindications to oral anticoagulants. |
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