Outcomes of Combined Left Atrial Appendage Occlusion and Transcatheter Mitral Edge-to-Edge Repair
Background: Up to 50% of patients undergoing mitral transcatheter edge-to-edge repair (MTEER) have an indication for left atrial appendage occlusion (LAAO). However, prospective evaluation of this strategy is lacking. Objectives: The aim of the study was to prospectively evaluate the outcomes of com...
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Elsevier
2025-02-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X24008214 |
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| author | Abdullah Al-Abcha, MD Pietro Di Santo, MD Charanjit S. Rihal, MD, MBA Trevor Simard, MD, PhD Benjamin Hibbert, MD, PhD Mohamad Alkhouli, MD, MBA |
| author_facet | Abdullah Al-Abcha, MD Pietro Di Santo, MD Charanjit S. Rihal, MD, MBA Trevor Simard, MD, PhD Benjamin Hibbert, MD, PhD Mohamad Alkhouli, MD, MBA |
| author_sort | Abdullah Al-Abcha, MD |
| collection | DOAJ |
| description | Background: Up to 50% of patients undergoing mitral transcatheter edge-to-edge repair (MTEER) have an indication for left atrial appendage occlusion (LAAO). However, prospective evaluation of this strategy is lacking. Objectives: The aim of the study was to prospectively evaluate the outcomes of combined LAAO and MTEER. Methods: The WATCH-TEER study is a prospective multicenter registry that aims to assess the feasibility and safety of concomitant MTEER with MitraClip and LAAO with WATCHMAN-FLX in patients with an approved clinical indication for both procedures. The primary endpoint was a composite of all-cause mortality, stroke, life-threatening, or major bleeding at 45 days. Results: A total of 24 patients were included between October 2020 and March 2024. Mean age was 79.5 ± 6.3 years, and 83% were males. The Society of Thoracic Surgeons operative risk score was 11.8% ± 5.3%, the CHA2DS2-VASc score was 4.5 ± 1.1, and the HAS-BLED score was 3.3 ± 1.5. Total procedure time was 103.6 ± 33.7 minutes. At 45 days, the primary endpoint occurred in 21% (95% CI: 5%-37%, n = 5/24) of patients, all of which occurred after discharge including 1 cardiac death, 1 ischemic stroke, 1 trauma-related intracranial hemorrhage, and 2 nonprocedural major bleeds. At 45 days, most patients (68%) had ≤2+ mitral regurgitation, and 72% of patients were in NYHA functional class I-II symptoms. Additionally, 71% of patients were not on anticoagulation, compared with only 20% at baseline. Conclusions: Combining LAAO with MTEER is feasible in patients who have a clinical indication for both procedures. |
| format | Article |
| id | doaj-art-439ba8b0650b4e9f93eaad0eeeb5d4b4 |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-439ba8b0650b4e9f93eaad0eeeb5d4b42025-01-09T06:17:05ZengElsevierJACC: Advances2772-963X2025-02-0142101541Outcomes of Combined Left Atrial Appendage Occlusion and Transcatheter Mitral Edge-to-Edge RepairAbdullah Al-Abcha, MD0Pietro Di Santo, MD1Charanjit S. Rihal, MD, MBA2Trevor Simard, MD, PhD3Benjamin Hibbert, MD, PhD4Mohamad Alkhouli, MD, MBA5Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADepartment of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADepartment of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Address for correspondence: Dr Mohamad Alkhouli, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, Minnesota 55905, USA.Background: Up to 50% of patients undergoing mitral transcatheter edge-to-edge repair (MTEER) have an indication for left atrial appendage occlusion (LAAO). However, prospective evaluation of this strategy is lacking. Objectives: The aim of the study was to prospectively evaluate the outcomes of combined LAAO and MTEER. Methods: The WATCH-TEER study is a prospective multicenter registry that aims to assess the feasibility and safety of concomitant MTEER with MitraClip and LAAO with WATCHMAN-FLX in patients with an approved clinical indication for both procedures. The primary endpoint was a composite of all-cause mortality, stroke, life-threatening, or major bleeding at 45 days. Results: A total of 24 patients were included between October 2020 and March 2024. Mean age was 79.5 ± 6.3 years, and 83% were males. The Society of Thoracic Surgeons operative risk score was 11.8% ± 5.3%, the CHA2DS2-VASc score was 4.5 ± 1.1, and the HAS-BLED score was 3.3 ± 1.5. Total procedure time was 103.6 ± 33.7 minutes. At 45 days, the primary endpoint occurred in 21% (95% CI: 5%-37%, n = 5/24) of patients, all of which occurred after discharge including 1 cardiac death, 1 ischemic stroke, 1 trauma-related intracranial hemorrhage, and 2 nonprocedural major bleeds. At 45 days, most patients (68%) had ≤2+ mitral regurgitation, and 72% of patients were in NYHA functional class I-II symptoms. Additionally, 71% of patients were not on anticoagulation, compared with only 20% at baseline. Conclusions: Combining LAAO with MTEER is feasible in patients who have a clinical indication for both procedures.http://www.sciencedirect.com/science/article/pii/S2772963X24008214atrial fibrillationleft atrial appendage occlusionmitral regurgitationtranscatheter mitral edge-to-edge repair |
| spellingShingle | Abdullah Al-Abcha, MD Pietro Di Santo, MD Charanjit S. Rihal, MD, MBA Trevor Simard, MD, PhD Benjamin Hibbert, MD, PhD Mohamad Alkhouli, MD, MBA Outcomes of Combined Left Atrial Appendage Occlusion and Transcatheter Mitral Edge-to-Edge Repair JACC: Advances atrial fibrillation left atrial appendage occlusion mitral regurgitation transcatheter mitral edge-to-edge repair |
| title | Outcomes of Combined Left Atrial Appendage Occlusion and Transcatheter Mitral Edge-to-Edge Repair |
| title_full | Outcomes of Combined Left Atrial Appendage Occlusion and Transcatheter Mitral Edge-to-Edge Repair |
| title_fullStr | Outcomes of Combined Left Atrial Appendage Occlusion and Transcatheter Mitral Edge-to-Edge Repair |
| title_full_unstemmed | Outcomes of Combined Left Atrial Appendage Occlusion and Transcatheter Mitral Edge-to-Edge Repair |
| title_short | Outcomes of Combined Left Atrial Appendage Occlusion and Transcatheter Mitral Edge-to-Edge Repair |
| title_sort | outcomes of combined left atrial appendage occlusion and transcatheter mitral edge to edge repair |
| topic | atrial fibrillation left atrial appendage occlusion mitral regurgitation transcatheter mitral edge-to-edge repair |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X24008214 |
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