Simultaneous Transcatheter Aortic Valve Implantation and Left Atrial Appendage Occlusion versus both Interventions as Stand-Alone Procedures

ABSTRACT

Background: Patients with atrial fibrillation undergoing transcatheter aortic valve implantation (TAVI) have a worse prognosis than those in sinus rhythm. The bleeding risk associated with oral anticoagulation accounts for some of this difference. Left atrial appendage occlusion (LAAO) omits the need for oral anticoagulation in patients with atrial fibrillation. We investigated the feasibility of simultaneous TAVI and LAAO with Lotus and Watchman and compared the results to both interventions as stand-alone procedures.

Methods: Fifty-two consecutive patients who underwent either TAVI with Lotus (n = 19), LAAO with Watchman (n = 23) or both procedures simultaneously (n = 10) were investigated. Procedural characteristics, in-hospital- and 30-day-outcomes defined by VARC-2 criteria were compared.

Results: There was no significant difference in the amount of contrast medium used between the three groups (TAVI: 89 ± 29 mL; LAAO: 98 ± 54 mL; TAVI + LAAO: 86 ± 29mL; p = 0.923). The total procedural time was significantly longer in the combined group (TAVI: 57.1 ± 18.0 minutes; LAAO: 42.7 ± 16.0 minutes; TAVI + LAAO: 82.0 ± 18.6 minutes; p = 0.001). Procedural and device success was achieved in all patients. The length of hospital stay was lower in the isolated LAAO group but did not differ significantly in the two groups including TAVI (TAVI: 9.7 ± 4.3 days; LAAO: 2.0 ± 2.1 days; TAVI + LAAO: 10 ± 4 days; p < 0.001). One sudden cardiac death occurred in the combined group at home on day 28. There was one cerebrovascular event and one major bleeding event in the isolated TAVI group.

Conclusion: Combining TAVI and LAAO with Lotus and Watchman is feasible and was comparable to both interventions as stand-alone procedures.

KEYWORDS:

• Transcatheter aortic valve implantation
• transcatheter aortic valve replacement
• left atrial appendage occlusion
• atrial fibrillation
• high bleeding risk
• oral anticoagulation

Disclosure statement

This study was not supported by the industry. Dr Binder is proctor for Boston Scientific and consultant for Edwards Lifesciences. Outside this study, as head of the Zurich Heart Foundation Dr Luescher has received educational and research grants from Boston Scientific, Biotronik, Medtronic and St. Jude Medical.

Additional information

Notes on contributors

Ronald K. Binder

All authors listed above made substantial contributions to the manuscript by collecting or analyzing data as well as assisting in writing or editing. They provided the corresponding author with the permission to be named in the manuscript. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.