Feasibility of combined therapy: percutaneous left atrial appendage closure and transcatheter edge-to-edge repair.

Abstract

Patients with atrial fibrillation (AF) often present with concomitant significant mitral regurgitation (MR). Percutaneous left atrial appendage closure (LAAC) is indicated for patients with AF to prevent thromboembolism and reduce the need for long-term anticoagulation. Transcatheter edge-to-edge repair (TEER) is recommended for patients with significant MR. However, the feasibility and efficacy of combining these therapeutic interventions remain uncertain. This study included consecutive patients who underwent LAAC. Feasibility was assessed by comparing outcomes between those undergoing combined LAAC + TEER and those receiving LAAC alone. Among 192 patients, 11 underwent the combined LAAC + TEER procedure, while 181 underwent LAAC alone. Procedural success was high in both groups (100% vs. 99%). At the 1-year follow-up, the incidence of significant device leak and device-related thrombus did not differ significantly between the groups (0% vs. 1.1% and 0% vs. 6.7%, respectively; p > 0.05 for both). Additionally, the cumulative incidence of thromboembolic and bleeding events was comparable between the two groups (thromboembolic p = 0.57 and bleeding p = 0.42). The combination of LAAC + TEER may be a feasible and effective therapeutic strategy when performed in carefully selected patients at high-volume, experienced centers.