Up-to-date review on concomitant mitral transcatheter edge-to-edge repair and left atrial appendage occlusion.

Abstract

In patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER), atrial fibrillation is a common comorbidity. While oral anticoagulation is the mainstay of stroke prevention therapy in most patients with atrial fibrillation, patients undergoing M-TEER might have a unique opportunity to undergo concomitant left atrial appendage occlusion (LAAO). LAAO is an alternative to oral anticoagulation that reduces the long-term risk of stroke and major bleeding, but it comes with upfront peri-procedural risk. M-TEER and LAAO share numerous procedural characteristics including large-bore venous access, transseptal puncture, general anesthesia, and real-time imaging of the left atrium with echocardiography. Therefore, performing concomitant LAAO at the time of M-TEER might be an attractive option for patients to lessen the cumulative peri-procedural risk, repeated anesthetic, and hospital visits from separate procedures. With rapidly evolving device technologies and an increasing evidence base for LAAO use, there is still limited data evaluating the safety and feasibility of concomitant M-TEER and LAAO. This up-to-date narrative review on concomitant M-TEER and LAAO aims to summarize the current body of literature, review practical procedural considerations, and review the unmet research questions limiting the widespread adoption of this concomitant intervention.