| Background and Objective : Left Atrial Appendage Clusure(LAAC)is increasingly used in clinical practice,but the physiological consequences of LAAC are still being explored.Although some studies have shown that the expression of natriuretic peptide can be affected in the short term after LAAC,the long-term effects of LAAC on patients’ neuroendocrine function,especially on the hormones related sympathetic nervous system and renin-angiotensin-aldosterone system(RAAS),have not been reported yet.The purpose of this study was to investigate the long-term effects of LAAC with the Watchman left atrial appendage occlusion device on patients’ neuroendocrine function with non-valvular atrial fibrillation(NVAF),and to observe the safety of the operation during the follow-up period.Methods:Patients with NVAF who received LAAC alone with the Watchman left atrial appendage occlusion device in the Department of Cardiology of XXX People’s Hospital from May 2019 to February 2020 were selected for a 12-month follow-up study.The effect of LAAC on neuroendocrine function in patients with NVAF was evaluated by comparing changes in N-terminal proAtrial Natriuretic Peptide(NT-proANP),N-terminal proB-type natriuretic peptide(NT-proBNP),adrenaline and aldosterone levels in 1-day preoperative and 12-month postoperative,and the safety of LAAC was also observed throughout the follow-up period.1.Baseline data of the study subjects were collected,including gender,age,body mass index,NVAF type,date of surgery and follow-up,underlying disease,CHA2DS2-VASC score and HA-Bled score.Left atrial diameter,left ventricular ejection fraction and valve regurgitation were measured by Transthoracic Echocardiography(TTE).Dual source CT was used to exclude thrombus in the left atrial appendage.2.Detailed documentation of the procedure was recorded: the depth and maximum opening diameter of the left atrial appendage measured by intraoperative angiography and Transesophageal Echocardiography(TEE),the type,compression rate,recovery and re-release of the occlusion device implanted and the residual shunt around the occlusion device,as well as the perioperative complications were recorded.3.Postoperative antithrombotic protocols were developed,and patients were informed of outpatient follow-up at 3 and 12 months after surgery,respectively.Repeat check dual-source CT and TTE,the data of occluder residual shunt,occluder surface thrombosis,occluder endothelization,left ventricular ejection fraction,and left atrium size,surgical complications,antithrombotic drug complications,cerebrovascular accidents,and all-cause death were recorded.The follow-up data were statistically analyzed to evaluate the long-term safety of the operation.The use of drugs that might have influenced the results was also recorded.4.Peripheral venous blood samples were taken from patients 1 day before surgery and 12 months after surgery in the morning,and serum samples were extracted.All serum samples were stored in an ultra-low temperature refrigerator at-70℃.After all samples were collected,relevant indicators were determined uniformly.Enzyme Linked Immunosorbent assay(ELISA)was used to determine the concentrations of adrenaline,aldosterone,NT-proANP and NT-proBNP in serum of the patients.The experimental data were statistically analyzed and the statistical differences between the two groups of data were compared to evaluate the influence of LAAC on the neuroendocrine function of patients.5.SPSS 23.0 was used to analyze the experimental data and compare the statistical differences.Result:We screened 24 patients into the study cohort.1.Baseline conditions: age(71.17±7.56)years,11 cases(45.8%)were female,13cases(54.2%)were male,body mass index was 24.80 ± 2.44;NVAF type: persistent NVAF in 18cases(75.0%),permanent NVAF in 6 cases(25.0%);underlying diseases:coronary atherosclerotic heart disease in 5 cases(20.8%),hypertension in 18cases(75.0%),vascular disease in 21 cases(87.5%),previous stroke or history of thromboembolism in 4 cases(16.7%),previous history of gastrointestinal bleeding in 1cases(4.2%);CHA2DS2-VASc score 3.83 ± 1.55,HAS-BLED score 2.67 ± 0.87.Baseline characteristics of TTE in preoperative patients: left atrial internal diameter50.42 ± 5.12 mm,left ventricular ejection fraction 61.38 ± 8.94%,mild mitral regurgitation in 15 cases(62.5%),mild aortic regurgitation in 7 cases(29.2%),mild tricuspid regurgitation in 8 cases(33.3%),and mild pulmonary regurgitation in 2 cases(8.3%).2.Surgical situation and complications: All 24 patients successfully completed LAAC,the surgical procedure was simple LAAC,the mean inner diameter of the left atrial appendage orifice was 23.40±3.94 mm,the mean depth of the left atrial appendage was 26.66±5.06 mm,the size range of the Watchman Left Atrial Appendage occlusion device selected was 21-33 mm,the intraoperative compression rate of the occlusion device was 19.85±5.10%,and no residual shunt was detected by TEE immediately after blocking.All patients had a successful release of the occlusion device,and there were no cases of recovery and re-release or replacement of the occlusion device.There were no perioperative complications in any of the patients.3.Follow-up cercumstance: When following-up to 3 months,Dual-source CT suggested 5 patients(20.8%)have residual shunts of <5 mm(1.4 mm,2.0 mm,2.0 mm,1.8 mm,2.0 mm,respectively),12 patients(50.0%)have incomplete endothelialization of the occlusion device surface,no occlusion device surface thrombosis was found in patients.When following-up to 12 months,all patients’ dual-source CT suggested no residual shunt of the occlusion device and the surface of occlusion device was completely endothelialized without any occlusion device surface thrombus.There were no cases of pericardial effusion,stroke or TIA,occlusion device displacement,hemorrhagic disease,or death during the follow-up period.There was no change in the use of antihypertensive drugs and antiarrhythmic drugs in 24 patients during the follow-up period.When following-up to 12 months,patients had no significant change in left ventricular ejection fraction compared with preoperative(P > 0.05)and we could find a significant reduction in left atrial internal diameter compared with preoperative(preoperative: 50.42 ± 5.12 mm,12-month postoperative: 48.67 ± 6.61 mm,t = 2.333,p= 0.029).4.Changes in neuroendocrine indices: compared with preoperative levels,there was no statistical difference in the changes in the levels of NT-proANP,NT-proBNP and epinephrine in patients 12 months after surgery(P>0.05).In contrast,aldosterone levels decreased significantly(1-day preoperative: 272.29±162.08 pg/ml,12-month postoperative: 210.84±131.45 pg/ml,t=2.321,P=0.030).There was no correlation between the size of the blocker compression rate and the decrease in aldosterone postoperatively(Kendall’s tau-b=0.117,P=0.437).Conclusion :1.NVAF patients undergoing simple LAAC with Watchman occlusion device have a high success rate and good safety at long-term follow-up.2.LAAC has an effect on the long-term neuroendocrine function of patients after surgery,which is mainly manifested by the decrease of serum aldosterone level. |
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