Combined transcatheter aortic valve replacement and left atrial appendage occlusion in patients ineligible for oral anticoagulation: A case series

• Published in: Journal of cardiology cases Vol. 26; no. 3; pp. 181 - 185
• Main Authors: Freire, Antônio Fernando Diniz, Filippini, Filippe Barcellos, Bignoto, Tiago Costa, de Brito, Pedro Henrique Ferro, Nicz, Pedro Felipe Gomes, Melo, Pedro Henrique Magalhães Craveiro de, e Silva, Ricardo Cavalcante, Queiroga, Marcelo, Ribeiro, Henrique Barbosa, Procópio, Arthur Guilherme Magalhães, Bezerra, Cristiano Guedes, Grube, Eberhard, Abizaid, Alexandre, Filho, Roberto Kalil, de Brito, Fábio S.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.09.2022; Japanese College of Cardiology
• Subjects: Anticoagulation; Antiplatelet; Aortic valve; Atrial fibrillation; Case Report; Stenosis; Thrombus; Valve replacement; Antiplatelet; Valve replacement; Atrial fibrillation; Thrombus; Stenosis; Anticoagulation; Aortic valve
• DOI: 10.1016/j.jccase.2022.04.008
• ISSN: 1878-5409

Patients presenting with aortic stenosis and atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR) are commonly at increased risk for stroke and bleeding complications. Concomitant left atrial appendage occlusion (LAAO) after TAVR may be an alternative to oral anticoagulation (OAC). Between 2018 and 2022, 7 consecutive patients who were ineligible for OAC underwent simultaneous TAVR and LAAO. The mean age was 84.9 ± 4.9 years. The mean CHA2DS2-VASc, HAS-BLED, and STS predicted risk of mortality scores were 5.9 ± 0.7, 3.9 ± 1.1, and 8.8 ± 3.4%, respectively. The median follow-up time was 23 (1 to 27) months. All procedures achieved technical success and no adverse events were observed during follow-up. This case series shows that concomitant TAVR and LAAO is feasible and safe among patients with severe aortic stenosis and AF who are deemed ineligible for OAC. Atrial fibrillation is the most common arrhythmia in the transcatheter aortic valve replacement (TAVR) population. In those who experience major or life-threatening bleeding, mortality is doubled. We report a case series of 7 concomitant left atrial appendage occlusions (LAAO) after TAVR in patients ineligible for oral anticoagulation. All procedures achieved technical success and no adverse events were observed. The simultaneous approach with TAVR and LAAO was feasible and safe in this case series.