BACKGROUND: Bacterial pneumonia is one of the most common causes of acute respiratory distress syndrome. In fulminant cases, when mechanical ventilation fails, veno-venous extracorporeal membrane oxygenation is required. However, this method is still associated with significant mortality and a wide range of potential complications. However, there are now many case reports of good outcomes even in patients with prolonged extracorporeal oxygenation, as in our rather complicated case report. CASE PRESENTATION: Our case report describes a complicated but successful treatment of a severe, devastating bacterial pneumonia in a 39-year-old European polymorbid woman with a rare form of diabetes mellitus, which had been poorly compensated for a long time with limited compliance, in the context of a combined immunodeficiency that strongly influenced the course of the disease. The patient's hospitalization required a total of 30 days of veno-venous extracorporeal membrane oxygenation therapy and more than 50 days of mechanical ventilation. Numerous complications, particularly bleeding, required seven chest drains, two extracorporeal membrane oxygenation circuit changes, and one surgical revision. The patient's mental state required repeated psychiatric intervention. CONCLUSION: It is possible that even the initially severely damaged lung parenchyma can develop its regenerative potential if suitable conditions are provided for this process, including a sufficiently long period of extracorporeal membrane oxygenation. We believe that this case report may also contribute to the consideration of the indications and contraindications of extracorporeal support. The authors also discuss the limitations and risks of prolonged veno-venous extracorporeal membrane oxygenation support and periprocedural anticoagulation strategies.

• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Pneumonia, Bacterial * therapy   complications   MeSH
• Adult MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * methods   MeSH
• Respiratory Distress Syndrome therapy   MeSH
• Respiration, Artificial MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Review MeSH

Autoři originálního textu European Society of Cardiology (ESC):F. Andreotti, T. Geisler, J. P. Collet et al.První mezinárodní doporučené postupy (guidelines) pro antitrombotickou léčbu publikovala Pracovní skupina pro trombózu u starších osob při Evropské kardiologické společnosti (European Society of Cardiology Working Group on Thrombosis) v roce 2015. Stejná pracovní skupina aktualizovala svoji předchozí zprávu o antiagreganciích a antikoagulanciích pro starší pacienty s akutními nebo chronickými koronárními syndromy, fibrilací síní nebo pro pacienty podstupující operace nebo výkony typické pro starší osoby (katetrizační implantace aortální chlopně a uzávěr ouška levé síně). Cílem je nabídnout stručný a výstižný, a přitom komplexní nástroj pro čtenáře, aby se seznámili se základy antitrombotické léčby u starších pacientů, přestože existují ještě i další, důležité faktory jako jsou komorbidity, komedikace a nejistá rovnováha mezi rizikem ischemie vs. krvácením. Údaje z nejnovějších studií a další důkazy jsou začleněny do 14 aktualizovaných konsenzuálních stanovisek se zvláštní pozorností věnovanou vysokému riziku krvácení. Doporučení tohoto dokumentu, pokud jsou uvedena, jsou zvýrazněna stejně jako dosud existující mezery v důkazech. Mezi klíčové body konsenzu patří úsilí o zlepšení adherence k farmakoterapii formou depreskripce a užívání fixních kombinací léků; přijetí univerzálních defi nic rizika pro krvácení, infarkt myokardu, cévní mozkovou příhodu(CMP) a úmrtí z konkrétních příčin; četné strategie prevence krvácení počínaje gastroprotekcí s užíváním kyseliny acetylsalicylové až po volbu složení antitrombotik, dávkování a délky jejich podávání přesně nastavených podle řady proměnných (prostředí, anamnéza, celkové riziko, věk, tělesná hmotnost, ledvinné funkce, komedikace, výkony), jež je nutno zvláště brát v úvahu při péči o starší dospělé.

The fi rst international guidance on antithrombotic therapy in the elderly came from the European Society of Cardiology Working Group on Thrombosis in 2015. This same group has updated its previous report on antiplatelet and anticoagulant drugs for older patients with acute or chronic coronary syndromes, atrial fi brillation, or undergoing surgery or procedures typical of the elderly (transcatheter aortic valve implantationand left atrial appendage closure). The aim is to provide a succinct but comprehensive tool for readers to understand the bases of antithrombotic therapy in older patients, despite the complexities of comorbidities, comedications and uncertain ischaemic- vs. bleeding-risk balance. Fourteen updated consensus statements integrate recent trial data and other evidence, with a focus on high bleeding risk. Guideline recommendations,when present, are highlighted, as well as gaps in evidence. Key consensus points include efforts to improve medical adherence through deprescribing and polypill use; adoption of universal risk defi nitions for bleeding, myocardial infarction, stroke and cause-specifi c death; multiple bleeding-avoidance strategies, ranging from gastroprotection with aspirin use to selection of antithrombotic-drug composition, dosing and duration tailored to multiple variables (setting, history, overall risk, age, weight, renal function, comedications, procedures) that need special consideration when managing older adults.

• MeSH
• Medication Adherence MeSH
• Patient Safety MeSH
• Dual Anti-Platelet Therapy MeSH
• Platelet Aggregation Inhibitors * administration & dosage   classification   MeSH
• Cardiovascular Diseases prevention & control   MeSH
• Clinical Studies as Topic MeSH
• Comorbidity MeSH
• Hemorrhage prevention & control   MeSH
• Humans MeSH
• Risk MeSH
• Heart Disease Risk Factors MeSH
• Aged MeSH
• Thrombosis drug therapy   MeSH
• Age Factors MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Practice Guideline MeSH

V článku je prezentována kazuistika pacienta s idiopatickou arteriální trombózou, u kterého se po léčbě heparinem a hybridním revaskularizačním výkonu vyvinula heparinem indukovaná trombocytopenie (HIT). Následně po odeznění akutní trombocytopenie byl pacientovi implantován dočasný kavální filtr jako profylaxe periprocedurální embolizace při nově zjištěné vysoké žilní trombóze v rámci další perkutánní revaskularizační intervence pro progredující arteriální končetinovou trombózu. Je popsán vznik trombotické komplikace v kaválním filtru i při probíhající antikoagulační terapii dabigatranem s poukázáním na vyšší riziko těchto komplikací ve spojitosti s HIT, jsou zmíněny výsledky malých studií, které toto riziko potvrzují. V kazuistice je dokumentována kompletní regrese kavální trombózy po vysazení dabigatranu a nastavení terapie warfarinem s cílovou hodnotou INR 2,0-3,0 v kombinaci s kyselinou acetylsalicylovou. Stručně jsou probrány informace o současné doporučené antitrombotické léčbě u pacientů s HIT s odkazem na nedávné menší práce zabývající se efektem léčby nových perorálních antikoagulancií (NOAC) u těchto nemocných.

The article presents a case report of a patient with idiopathic arterial thrombosis who developed heparin-induced thrombocytopenia (HIT) after heparin treatment and hybrid revascularization. After disappearance of acute thrombocytopenia, the patient was implanted with a temporary caval filter as a prophylaxis of periprocedural embolization in newly diagnosed high venous thrombosis as part of another percutaneous revascularization intervention for progressive arterial limb thrombosis. The occurrence of thrombotic complications in the caval filter and during ongoing anticoagulant therapy with dabigatran is described, pointing to the higher risk of these complications in connection with HIT, the results of small studies that confirm this risk are mentioned. The case report documents a complete regression of caval thrombosis after discontinuation of dabigatran and adjustment of warfarin therapy with a target INR level of 2.0-3.0 in combination with aspirin. Information on the current recommended antithrombotic treatment in patients with HIT is briefly discussed with reference to recent small trials on the effect of NOACs in these patients.

• MeSH
• Anticoagulants therapeutic use   MeSH
• Administration, Oral MeSH
• Aspirin therapeutic use   MeSH
• Dabigatran therapeutic use   MeSH
• Adult MeSH
• Fibrinolytic Agents therapeutic use   MeSH
• Fondaparinux therapeutic use   MeSH
• Heparin adverse effects   therapeutic use   MeSH
• Vena Cava Filters MeSH
• Clopidogrel therapeutic use   MeSH
• Drug Therapy, Combination methods   MeSH
• Humans MeSH
• Drug-Related Side Effects and Adverse Reactions drug therapy   MeSH
• Heart Disease Risk Factors MeSH
• Practice Guidelines as Topic MeSH
• Embolization, Therapeutic MeSH
• Vascular Grafting methods   MeSH
• Thrombocytopenia * chemically induced   drug therapy   MeSH
• Thrombosis * drug therapy   complications   therapy   MeSH
• Warfarin therapeutic use   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Katetrizační implantace aortální chlopně (TAVI) je stejně jako všechny biologické chlopenní protézy spojena s užíváním antitrombotické terapie, jejímž cílem je minimalizovat riziko tromboembolických a ischemických příhod při nízkém výskytu krvácivých komplikací. Periprocedurální i dlouhodobá léčebná antitrombotická strategie byla v počátcích této metody převzata od terapie po perkutánních koronárních intervencích bez jakékoli dostupné evidence. Současná doporučení antitrombotické terapie u pacientů postupujících TAVI jsou založena na zkušenostech a konsensu expertů, přičemž používání antitrombotické terapie v klinické praxi se často dle různých pracovišť liší. Cílem tohoto článku je poskytnout přehled současných poznatků týkajících se optimální antitrombotické strategie pacienta po TAVI. První data z randomizovaných studií směřují spíše k méně intenzivní monoterapii; v případě pacientů bez indikace k antikoagulaci k monoterapii aspirinem a v případě pacientů s indikovanou antikoagulační terapií pouze k antikoagulaci samotné. Je však třeba vyčkat na potvrzení těchto dat v dalších studiích a také v delším časovém horizontu.

Transcatheter aortic valve implantation (TAVI), as is the case with all bioprosthetic valves, requires the use of antithrombotic therapy to minimise thromboembolic and ischaemic events while keeping the incidence of bleeding complications low. Periprocedural and long-term antithrombotic strategy after TAVI was, from the beginning, empirically based on the treatment administered after percutaneous coronary interventions. Current guidelines for antithrombotic therapy after TAVI are based on experience and consensus of experts; however, there are significant practice variations among different hospitals and countries. This article aims to provide an overview of the current knowledge on an optimal post-TAVI antithrombotic strategy. The first randomised data point in the direction of less aggressive monotherapy; aspirin monotherapy in patients without indication for anticoagulation; and anticoagulation alone in those with an already established indication for anticoagulation therapy before TAVI. However, these results must be confirmed in further studies as well as in longer-term follow-up.

• MeSH
• Anticoagulants * therapeutic use   MeSH
• Platelet Aggregation Inhibitors * therapeutic use   MeSH
• Hemorrhage prevention & control   MeSH
• Humans MeSH
• Postoperative Care MeSH
• Transcatheter Aortic Valve Replacement * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

AIMS: This post hoc analysis of ELIMINATE-AF evaluated requirements of unfractionated heparin (UFH) and procedure-related bleeding in atrial fibrillation (AF) patients undergoing ablation with uninterrupted edoxaban or vitamin K antagonist (VKA) therapy. METHODS AND RESULTS: Patients were randomized 2:1 to once-daily edoxaban 60 mg (or dose-reduced 30 mg) or dose-adjusted VKA (target international normalized ratio: 2.0-3.0). Uninterrupted anticoagulation was mandated for 21-28 days' pre-ablation and 90 days' post-ablation. During ablation, UFH administration targeted an activated clotting time (ACT) of 300-400 s. Periprocedural bleeding was differentiated between procedure-related (bleeding at puncture side, cardiac tamponade) and unrelated events. Of 614 randomized patients, 553 received study drug and underwent catheter ablation (edoxaban n = 375; VKA n = 178). The median (Q1-Q3) time from last dose to ablation procedure was 14.8 (13.3-16.5) vs. 16.5 (14.8-19.5) h (edoxaban vs. VKA group, respectively). Mean ACT (SD) ≥300 s was observed in 52% edoxaban- vs. 76% VKA-treated patients, despite a higher mean (SD) UFH dose in the edoxaban vs. VKA group [14 261 (6397) IU vs. 11 473 (4300) IU; exploratory P-value < 0.0001]. In the edoxaban group, 13 patients (3.5%) had procedure-related bleeds of whom 9 had received an UFH dose above the median (13 000 IU). In the VKA arm, 7 patients (3.9%) had procedure-related bleeds of whom 3 had received an UFH dose above the median (10 225 IU). CONCLUSION: The rate of procedure-related major/clinically relevant non-major bleeding did not differ between the treatment arms despite higher doses of UFH used with edoxaban vs. VKA to achieve a target ACT during AF ablation.

• MeSH
• Anticoagulants adverse effects   MeSH
• Administration, Oral MeSH
• Atrial Fibrillation * diagnosis   drug therapy   surgery   MeSH
• Heparin adverse effects   MeSH
• Catheter Ablation * adverse effects   MeSH
• Humans MeSH
• Pyridines MeSH
• Thiazoles MeSH
• Vitamin K MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH

Patients with atrial fibrillation (AF) are at an approximately 0.5% to 3% increased risk of thromboembolism during and immediately after catheter ablation. Treatment guidelines recommend periprocedural oral anticoagulation plus unfractionated heparin during ablation. Rivaroxaban and dabigatran are the only non-vitamin K oral anticoagulants for which there are randomized controlled trials assessing uninterrupted anticoagulation in patients undergoing catheter ablation of AF. Edoxaban, a direct factor Xa inhibitor, is noninferior vs warfarin for the prevention of stroke or systemic embolism with less major bleeding in patients with nonvalvular AF. The ELIMINATE-AF (Evaluation of Edoxaban Compared With VKA in Subjects Undergoing Catheter Ablation of Nonvalvular Atrial Fibrillation) trial is a multinational, multicenter, prospective, randomized, open-label, parallel-group, blinded-endpoint evaluation (PROBE) study to assess the safety and efficacy of once-daily edoxaban 60 mg (30 mg in patients indicated for a dose reduction) vs vitamin K antagonists (VKA) in patients with nonvalvular AF undergoing catheter ablation (http://www.ClinicalTrials.gov: NCT02942576). A total of 560 patients are planned for randomization to edoxaban or VKA (2:1 ratio) to obtain 450 patients fully compliant with the protocol. Patients will complete 21 to 28 days of anticoagulation prior to the ablation and a 90-day post-ablation period. The primary efficacy endpoint is the composite of all-cause death, stroke, and major bleeding. The primary safety endpoint is major bleeding. A magnetic resonance imaging substudy will assess the incidence of silent cerebral lesions post-ablation. ELIMINATE-AF will define the efficacy and safety of edoxaban for uninterrupted oral anticoagulation during catheter ablation of AF.

• MeSH
• Anticoagulants administration & dosage   adverse effects   MeSH
• Time Factors MeSH
• Stroke diagnostic imaging   etiology   prevention & control   MeSH
• Atrial Fibrillation complications   mortality   physiopathology   surgery   MeSH
• Factor Xa Inhibitors administration & dosage   adverse effects   MeSH
• Brain Ischemia diagnostic imaging   etiology   prevention & control   MeSH
• Catheter Ablation * adverse effects   mortality   MeSH
• Clinical Protocols MeSH
• Hemorrhage chemically induced   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Prospective Studies MeSH
• Pyridines administration & dosage   adverse effects   MeSH
• Risk Factors MeSH
• Drug Administration Schedule MeSH
• Thiazoles administration & dosage   adverse effects   MeSH
• Vitamin K antagonists & inhibitors   MeSH
• Treatment Outcome MeSH
• Research Design MeSH
• Warfarin administration & dosage   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

Atrial fibrillation (AF), with a prevalence of 1% to 2%, is the most common cardiac arrhythmia. Without antithrombotic treatment, the annual risk of a cardioembolic event is 5% to 6%. The source of a cardioembolic event is a thrombus, which is usually formed in the left atrial appendage (LAA). Prevention of cardioembolic events involves treatment with anticoagulant drugs: either vitamin K antagonists or, recently, novel oral anticoagulants (NOAC). The other (nonpharmacologic) option for the prevention of a cardioembolic event involves interventional occlusion of the LAA. OBJECTIVE: To determine whether percutaneous LAA occlusion is noninferior to treatment with NOAC in AF patients indicated for long-term systemic anticoagulation. STUDY DESIGN: The trial will be a prospective, multicenter, randomized noninferiority trial comparing 2 treatment strategies in moderate to high-risk AF patients (ie, patients with history of significant bleeding, or history of cardiovascular event(s), or a with CHA2DS2VASc ≥3 and HAS-BLED score ≥2). Patients will be randomized into a percutaneous LAA occlusion (group A) or a NOAC treatment (group B) in a 1:1 ratio; the randomization was done using Web-based randomization software. A total of 396 study participants (198 patients in each group) will be enrolled in the study. The primary end point will be the occurrence of any of the following events within 24months after randomization: stroke or transient ischemic attack (any type), systemic cardioembolic event, clinically significant bleeding, cardiovascular death, or a significant periprocedural or device-related complications. CONCLUSION: The PRAGUE-17 trial will determine if LAA occlusion is noninferior to treatment with NOAC in moderate- to high-risk AF patients.

• MeSH
• Anticoagulants therapeutic use   MeSH
• Stroke etiology   MeSH
• Embolism etiology   MeSH
• Atrial Fibrillation drug therapy   surgery   MeSH
• Cardiovascular Diseases mortality   MeSH
• Hemorrhage etiology   MeSH
• Quality of Life MeSH
• Humans MeSH
• Prospective Studies MeSH
• Atrial Appendage surgery   MeSH
• Vitamin K antagonists & inhibitors   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

Úvod: Léčba perzistentní a dlouhodobě perzistentní fibrilace síní není uspokojivě vyřešena pomocí katetrizační ablace či farmakoterapie. Nadějnou a stále častěji používanou metodou jsou tzv. hybridní ablace, tedy kombinace miniinvazivní kardiochirurgické ablace s následným elektrofyziologickým vyšetřením a endokardiální katetrizační ablací, která celou ablaci dokončí. Metoda: Prováděna byla thorakoskopická ablace plicních žil a zadní stěny levé síně (tzv. box-léze) systémem COBRA Fusion, u pozdějších pacientů doplněná o uzávěr ouška levé síně systémem AtriClip. Po 2−3 měsících pacienti podstoupili elektrofyziologické vyšetření a katetrizační ablaci. V článku shrnujeme strategii chirurgické části hybridní ablace prováděné na našem pracovišti a popisujeme vlastní operaci a krátkodobé výsledky, zejména ve vztahu k následným nálezům elektrofyziologů. Výsledky: Analyzována byla data prvních 51 pacientů. Prvních 25 pacientů podstoupilo jen unilaterální ablaci, průměrný čas výkonu byl 102 minut, u následujících 26 pacientů (bilaterální výkon) to bylo 160 minut. Závažnými komplikacemi byl 1 iktus, 1 paréza n. phrenicus a 2 operační revize pro krvácení. Po měsíci mělo 65 % pacientů sinusový rytmus. Box-léze byla při elektrofyziologickém vyšetření kompletní u 38 % pacientů a po katetrizační ablaci odcházelo 96 % pacientů se sinusovým rytmem. Závěr: Chirurgická část hybridní ablace pomocí miniinvazivního přístupu s využitím katétru COBRA Fusion je dobře proveditelnou metodou s nízkým počtem perioperačních komplikací a poskytuje elektrofyziologům velmi dobrý základ pro úspěšné dokončení hybridní ablace.

Introduction: Treatment of persistent and long-standing persistent atrial fibrillation is not successfully managed by methods of catheter ablation or pharmacotherapy. Hybrid ablation (i.e. combination of minimally invasive surgical ablation, followed by electrophysiological assessment and subsequent endocardial catheter ablation to complete the entire intended procedure) presents an ever more used and very promising treatment method. Method: Patients underwent thoracoscopic ablation of pulmonary veins and posterior wall of the left atrium (the box-lesion) with use of the COBRA Fusion catheter; thoracoscopic occlusion of the left atrial appendage using the AtriClip system was also done in later patients. After 2−3 months, electrophysiological assessment and catheter ablation followed. In this article we summarize a strategy of the surgical part of the hybrid procedure performed in our centre. We describe the surgery itself (including possible periprocedural complications) and we also present our short-term results, especially with respect to subsequent electrophysiological findings. Results: Data of the first 51 patients were analyzed. The first 25 patients underwent unilateral ablation; the mean time of surgery was 102 min. Subsequent 26 patients underwent the bilateral procedure with the mean surgery time of 160 min. Serious complications included 1 stroke, 1 phrenic nerve palsy and 2 surgical re-explorations for bleeding. After 1 month, 65% of patients showed sinus rhythm. The box-lesion was found complete during electrophysiological assessment in 38% of patients and after catheter ablation, 96% of patients were discharged in sinus rhythm. Conclusion: The surgical part of the hybrid procedure with use of the minimally invasive approach and the COBRA Fusion catheter is a well-feasible method with a low number of periprocedural complications. For electrophysiologists, it provides a very good basis for successful completion of the hybrid ablation.

• Keywords
• hybridní ablace,
• MeSH
• Anticoagulants MeSH
• Electrophysiologic Techniques, Cardiac MeSH
• Atrial Fibrillation * surgery   therapy   MeSH
• Heparin therapeutic use   MeSH
• Catheter Ablation MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures MeSH
• Thoracoscopy * methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Catheter and surgical ablation of atrial fibrillation (AF) can be associated with a risk of thromboembolic events. The goal of this study was to assess optimal anticoagulation management during thoracoscopic ablation of AF. METHODS: Fifty-two patients with persistent or long-standing persistent AF underwent hybrid ablation consisting of thoracoscopic ablation followed by electrophysiologic (EP) evaluation and consecutive ablation if indicated. The thoracoscopic ablation was performed using three different anticoagulation protocols: (1) without periprocedural heparin and without occlusion of the left atrial appendage; (2) with periprocedural heparin but without left atrial appendage occlusion; and (3) with periprocedural heparin and left atrial appendage occlusion. Transesophageal echocardiography (TEE) was obligatorily used to screen for intraatrial thrombi before the surgical and EP procedure and before hospital discharge for patients in protocols 2 and 3. RESULTS: In group 1 (n = 20), 1 patient (5%) had a postoperative stroke with persistent neurologic deficit, and 6 other patients (30%) had a new thrombus in the left atrial appendage seen on the pre-EP TEE. In group 2 (n = 6), 3 left atrial appendage thrombi occurred (50%; 2 on predischarge TEE and 1 on pre-EP TEE). In group 3 (n = 26), no intracardiac thrombi were found on predischarge and pre-EP TEE, and there were no strokes in this group of patients, namely, the rates of thrombus or stroke were significantly reduced when compared with groups 1 and 2 (p = 0.001). CONCLUSIONS: Thoracoscopic ablation of AF can be associated with a risk of left atrial appendage thrombus formation and possibly also stroke. With administration of heparin during the ablation, followed by occlusion of the left atrial appendage as a part of the procedure, this risk can be effectively reduced.

• MeSH
• Anticoagulants pharmacology   MeSH
• Stroke etiology   prevention & control   MeSH
• Adult MeSH
• Atrial Fibrillation complications   surgery   MeSH
• Heparin pharmacology   MeSH
• Incidence MeSH
• Catheter Ablation adverse effects   methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Atrial Appendage surgery   MeSH
• Thoracoscopy methods   MeSH
• Thrombosis epidemiology   etiology   prevention & control   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

Úvod: Fibrilace síní (FS) je zatížena velkým rizikem cévní mozkové příhody (CMP). Zásadní roli v etiopatognezi hraje ouško (LAA) levé síně (LS). Až 95 % trombů u nevalvulární FS je lokalizováno v oušku. Prevence CMP pak spočívá v trvalé antikoagulaci, která ale má své limity a rizika. Alternativní metodou je okluze ouška LS. V našem sdělení bychom rádi prezentovali novou možnost uzávěru pomocí epikardiálního systému AtriClip (AtriCure). Metodika: V období od července roku 2012 do září roku 2015 jsme uzavřeli ouško LS u 101 pacientů. Průměrný věk 65 ? 6 let, 47 žen, CHA2DS2 VASc (?) 2,47 (0–6). Sledování 1 837 (? 18,5) měsíců. Konkomitantní procedura byla provedena u 37 pacientů, endoskopický MAZE plus klip 57 u pacientů a izolovaně byl klip implantován u 7 pacientů. Klip byl naložen z plné sternotomie, minitorakotomie nebo torakoskopicky. Naložení klipu, zbytkový recesus a endoleak byly hodnoceny jícnovým ultrazvukem podle Clevelandských kritérií. Výsledky: Perioperační úspěšnost naložení byla 98%. Klip byl naložen s více než 1cm krčkem u 2 nemocných. Nedošlo k žádné migraci klipu, nebyl detekován žádný endoleak, nebyl detekován žádný trombus v bázi ouška. Periprocedurálně jsme zaznamenali jednu CMP. V následném sledování se u 4 pacientů objevila TIA a nebyla zaznamenána CMP. Závěr: Epikardiální okluze ouška LS systémem AtriClip je bezpečná a reprodukovatelná metoda uzávěru ouška LS a mohla by se stát důležitou alternativou v prevenci cévních mozkových příhod.

Introduction: Atrial fibrillation (AFib) is related to a high risk of stroke. The main role in etiopathogenesis is played by the left atrial appendage (LAA). As many as 95 % of thrombi in nonvalvular atrial fibrillation are located in the appendage. Prevention of stroke then consists in permanent anticoagulation which, however, has its limits and risks. An alternative method is the left atrial appendage occlusion. In our report, we would like to present a new possibility of the closure using the epicardial system AtriClip (AtriCure). Methodology: In the period beginning in July 2012 – September 2015 we performed LAA closure in 101 patients. A mean age of 65 ? 6 years, 47 women, CHA2DS2 VASc (?) 2.47 (0–6). Monitoring 1 837 (? 18.5) months. A concomitant procedure was performed in 37 patients, endoscopic MAZE plus clip in 57 patients, and 7 patients underwent stand-alone implantation of the clip. The clip was implanted from full sternotomy, minitoracotomy or through thoracoscopy. Clip loading, residual recess and endoleak were assessed through endoscopic ultrasound according to the Cleveland criteria. Results: The perioperative success rate of loading reached 98 %. The clip was loaded with a neck greater than 1 cm in 2 patients. No migration of the clip occurred, no endoleak was detected and no thrombus at the appendage base was detected. One case of periprocedural stroke was recorded. Within follow-up monitoring TIA occurred in 4 patients and no stroke was recorded. Conclusion: Epicardial LAA occlusion using the AtriClip system is a safe and reproducible method of LAA occlusion and an important alternative in the prevention of stroke.

• MeSH
• Anticoagulants therapeutic use   MeSH
• Stroke prevention & control   MeSH
• Atrial Fibrillation diagnosis   prevention & control   therapy   MeSH
• Clinical Trials as Topic MeSH
• Humans MeSH
• Atrial Appendage * surgery   MeSH
• Treatment Outcome MeSH
• Warfarin therapeutic use   MeSH
• Check Tag
• Humans MeSH