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

Autor: Freire AFD; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.; Hospital Sírio-Libanês, São Paulo, Brazil.; Hospital São Camilo, São Paulo, Brazil., Filippini FB; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.; Hospital São Camilo, São Paulo, Brazil., Bignoto TC; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil., de Brito PHF; Hospital Sírio-Libanês, São Paulo, Brazil., Nicz PFG; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.; Hospital Sírio-Libanês, São Paulo, Brazil.; Hospital São Camilo, São Paulo, Brazil., Melo PHMC; Hospital Sírio-Libanês, São Paulo, Brazil.; Hospital São Camilo, São Paulo, Brazil., E Silva RC; Hospital Sírio-Libanês, São Paulo, Brazil.; Hospital São Camilo, São Paulo, Brazil., Queiroga M; Hospital Nossa Senhora das Neves, João Pessoa, Brazil., Ribeiro HB; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.; Hospital Sírio-Libanês, São Paulo, Brazil., Procópio AGM; Hospital Unimed Recife, Recife, Brazil., Bezerra CG; Hospital Aliança, Salvador, Brazil., Grube E; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil., Abizaid A; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.; Hospital Sírio-Libanês, São Paulo, Brazil., Filho RK; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.; Hospital Sírio-Libanês, São Paulo, Brazil., de Brito FS Jr; The Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.; Hospital Sírio-Libanês, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Journal of cardiology cases [J Cardiol Cases] 2022 May 25; Vol. 26 (3), pp. 181-185. Date of Electronic Publication: 2022 May 25 (Print Publication: 2022).
DOI: 10.1016/j.jccase.2022.04.008
Abstrakt: 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.
Learning Objectives: 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.
Competing Interests: Dr. Ribeiro: proctor for Medtronic, Edwards Lifesciences, and Boston Scientific. Dr. Abizaid: proctor for Boston Scientific. Dr. de Brito Jr.: proctor for Boston Scientific, Edwards Lifesciences, and Medtronic.
(© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.)
Databáze: MEDLINE