Concomitant left atrial appendage occlusion in patients undergoing mitral transcatheter edge-to-edge repair: pros and cons

Patients with mitral regurgitation (MR) undergoing mitral transcatheter edge-to-edge repair (M-TEER) might also present indications for left atrial appendage occlusion (LAAO). While concomitant interventions are common in cardiac surgery, their role in interventional cardiology remains less clear. In particular, concomitant M-TEER and LAAO has the advantage of reducing the lifelong bleeding risk while avoiding repeat interventions. However, this combined strategy introduces clinical and procedural complexities that necessitate a careful evaluation of its benefits and drawbacks. Notably, apart from the presence of atrial fibrillation (AF) in many patients undergoing M-TEER, determining the indication and suitability for LAAO requires a thorough assessment encompassing clinical factors (e.g., bleeding risk, residual determinants of cardioembolism), procedural considerations (e.g., precise location of transseptal puncture, procedural duration), and practical aspects (e.g., reimbursement). Based on current knowledge, it is not definitively clear whether concomitant LAAO should be performed in patients undergoing M-TEER.

Fabian Nietlispach, MD, PhD; John G. Webb, MD

In AF patients, LAAO offers a similar protection from cardioembolic events as direct oral anticoagulants (DOACs) but reduces the risk of non-procedural clinically relevant bleeding by 45%...