循環器ジャーナル72巻3号

2024年07月発行

特集 心房細動—予防・早期発見・治療の進化 Ⅴ.抗凝固療法

ウルフ—オオツカ法による胸腔鏡下左心耳閉鎖術

著者： 大塚俊哉¹

所属機関： ¹ニューハート・ワタナベ国際病院ウルフ—オオツカ低侵襲心房細動手術センター

ページ範囲：P.459 - P.466

POINT
●ウルフ—オオツカ法は，左心耳を迅速・安全に切除して閉鎖する胸腔鏡下手術である．
●迅速かつ確実に抗凝固治療を離脱可能にし，極めて高い脳梗塞予防効果を発揮する．
●Watchman^TM移植術などの経皮的左心耳閉鎖法にはない利点がある．
●左心耳切除の副産物として，高血圧症例に対する降圧効果も期待できる．

参考文献

1）Aldrugh S, Sardana M, Henninger N, et al. Atrial fibrillation, cognition and dementia : A review. J Cardiovasc Electrophysiol 2017 ; 28 : 958-65.

2）Ohtsuka T, Nonaka T, Hisagi M, et al. Thoracoscopic stapler-closure of left atrial appendage and epicardial clamp-isolation of pulmonary veins in a patient with non-valvular atrial fibrillation and short bowel : A case report. Eur Heart J Case Rep 2019 ; 3 : ytz007.

3）Albers GW. Atrial fibrillation and stroke. Three new studies, three remaining questions. Arch Intern Med 1994 ; 154 : 1443-8.

4）Kühne M, Krisai P, Coslovsky M, et al. Silent brain infarcts impact on cognitive function in atrial fibrillation. Eur Heart J 2022 ; 43 : 2127-35.

5）Cresti A, García-Fernández MA, Sievert H, et al. Prevalence of extra-appendage thrombosis in non-valvular atrial fibrillation and atrial flutter in patients undergoing cardioversion : a large transoesophageal echo study. EuroIntervention 2019 ; 15 : e225-e230.

6）Burrell LD, Horne BD, Anderson J, et al. Usefulness of left atrial appendage volume as a predictor of embolic stroke in patients with atrial fibrillation. Am J Cardiol 2013 ; 112 : 1148-52.

7）Di Biase L, Santangeli P, Anselmino M, et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol 2012 ; 60 : 531-8.

8）Ohtsuka T, Ninomiya M, Nonaka T, et al. Thoracoscopic stand-alone left atrial appendectomy for thromboembolism prevention in nonvalvular atrial fibrillation. J Am Coll Cardiol 2013 ; 62 : 103-7.

9）Ohtsuka T, Nonaka T, Hisagi M, et al. Thoracoscopic stapler-and-loop technique for left atrial appendage closure in nonvalvular atrial fibrillation : Mid-term outcomes in 201 patients. Heart Rhythm 2018 ; 15 : 1314-20.

10）Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage : an underrecognized trigger site of atrial fibrillation. Circulation 2010 ; 122 : 109-18.

11）Ohtsuka T, Nonaka T, Hisagi M, et al. En Bloc left pulmonary vein and appendage isolation in thoracoscopic surgery for atrial fibrillation. Ann Thorac Surg 2018 ; 106 : 1340-7.

11）Turagam MK, Vuddanda V, Verberkmoes N, et al. Epicardial left atrial appendage exclusion reduces blood pressure in patients with atrial fibrillation and hypertension. J Am Coll Cardiol 2018 ; 72 : 1346-53.

12）Reddy VY, Doshi SK, Kar S, et al. 5-Year outcomes after left atrial appendage closure : from the PREVAIL and PROTECT AF trials. J Am Coll Cardiol 2017 ; 70 : 2964-75.

13）Hlaing KM, Aung TT, Kravitz K, et al. Who watches the “Watchman” and how often? Cureus 2020 ; 12 : e10077.

14）Sinanis T. A very late and persistent thrombosis after left atrial appendage occlusion. Heart Views 2019 ; 20 : 175-7.

15）Fauchier L, Cinaud A, Brigadeau F, et al. Device-related thrombosis after percutaneous left atrial appendage occlusion for atrial fibrillation. J Am Coll Cardiol 2018 ; 71 : 1528-36.

16）Cloud GC, Williamson JD, Thao LTP, et al. Low-dose aspirin and the risk of stroke and intracerebral bleeding in healthy older people : secondary analysis of a randomized clinical trial. JAMA Netw Open 2023 ; 6 : e2325803.

17）Turagam MK, Vuddanda V, Verberkmoes N, et al. Epicardial left atrial appendage exclusion reduces blood pressure in patients with atrial fibrillation and hypertension. J Am Coll Cardiol 2018 ; 72 : 1346-53.

18）Bartus K, Podolec J, Lee RJ, et al. Atrial natriuretic peptide and brain natriuretic peptide changes after epicardial percutaneous left atrial appendage suture ligation using LARIAT device. J Physiol Pharmacol 2017 ; 68 : 117-23.