Outcomes of simultaneous left atrial appendage closure in atrial fibrillation patients undergoing transcatheter aortic valve replacement

Abstract

Atrial fibrillation (AF) patients with aortic stenosis who undergo transcatheter aortic valve replacement (TAVR) are at an elevated risk for bleeding and stroke. We aim to evaluate clinical outcomes of concomitant TAVR and left atrial appendage closure (LAAC) versus isolated TAVR in patients with AF. We searched several databases for studies comparing concomitant TAVR and LAAC procedures versus isolated TAVR in patients with AF. We used a common-effect model to calculate risk ratios (RR) with 95% confidence intervals in R studio. Outcomes assessed were all-cause mortality, major bleeding, major vascular complications, and ischemic stroke. A total of 3 studies were identified consisting of 482 patients, of which 239 underwent TAVR with LAAC and 243 underwent isolated TAVR. All-cause mortality (RR 0.94; 95% CI 0.64 - 1.38), major bleeding (RR 1.18; 95% CI 0.77 - 1.81), and ischemic stroke (RR 0.83; 95% CI 0.38 - 1.80) were similar between both groups. Concomitant TAVR with LAAC was associated with a significantly increased risk of major vascular complications (RR 5.44; 95% CI 1.77 - 16.71) compared to isolated TAVR. Our findings suggest that patients undergoing concomitant TAVR with LAAC had an increased risk of major vascular complications when compared to those undergoing isolated TAVR. Additionally, ischemic stroke, mortality, and major bleeding were noted to be similar among patients who underwent concomitant TAVR with LAAC compared to those who underwent isolated TAVR. Further studies are indicated to confirm our findings.