Key result
LAAC shows similar adverse event rates in VKA-failure patients with versus without mechanical mitral valves.
Why the study?
In AF patients on VKA therapy, cardiac thromboembolism risk is non-negligible, with mechanical PMV carriers having the highest risk, prompting evaluation of LAAC after VKA failure.
Does percutaneous left atrial appendage closure (LAAC) improve the composite of all-cause death, MACE, and major bleeding in AF patients with mechanical prosthetic mitral valves and VKA failure compared to those without mechanical valves?
Cohort (n=55)
Yes
Does percutaneous left atrial appendage closure (LAAC) improve the composite of all-cause death, MACE, and major bleeding in AF patients with mechanical prosthetic mitral valves and VKA failure compared to those without mechanical valves?
Effect estimate: HR 0.73 (95% CI 0.25-2.16)
Absolute Event Rate: 33.3% vs 46.5%
p-value: p=0.564
Percutaneous left atrial appendage closure appears feasible and safe as an off-label alternative for AF patients with mechanical mitral valves who experience VKA failure, with long-term outcomes comparable to patients without mechanical valves.
Background In patients with atrial fibrillation (AF) on vitamin K antagonist (VKA) therapy and therapeutical INR range the incidence of cardiac thromboembolism is not negligible and the subgroup carrying a mechanical prosthetic mitral valve (PMV) has the highest risk. We aimed to assess the long-term effects of left atrial appendage closure (LAAC) in AF patients carriers of mechanical PMV who experienced a failure of VKA therapy. Methods In this retrospective, multicenter study, patients who underwent LAAC because of thrombotic events including TIA/stroke, systemic embolism and evidence of left atrial appendage thrombosis/sludge during VKA therapy were enrolled. Patients with mechanical PMV were included and compared with controls. The primary endpoint was the composite of all-cause death, major cardiovascular events and major bleedings at follow-up. Feasibility and safety of LAAC was also assessed. Results A total of 55 patients (42% females; mean age 70 ± 9 years) including 12 carriers of mechanical PMV were enrolled. The most frequent indication to LAAC (71%) was LAA thrombosis or sludge. Procedural success was achieved in 96% of overall cases and in 100% of patients with PMV. In 35 patients a cerebral protection device was used. During a median follow-up of 6.1 ± 4.3 years, 4 patients with PMV and 20 patients without PMV reported adverse events (HR 0.73 [95% CI 0.25 – 2.16, p=0.564]). Conclusion LAAC seems to be a valuable alternative in AF patients with failure of VKA therapy who are carriers of mechanical PMV. This off-label, real-world clinical practice indication deserve validation in further studies.
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Preda et al. (2023) conducted a cohort in Atrial fibrillation with failure of VKA therapy (n=55). Left atrial appendage closure (LAAC) vs. LAAC in patients without mechanical prosthetic mitral valve was evaluated on Composite of all-cause death, major adverse cardiovascular events (TIA/ischemic stroke, systemic embolism), and major bleeding (HR 0.73, 95% CI 0.25-2.16, p=0.564). Left atrial appendage closure in patients with mechanical mitral valve prosthesis and VKA failure resulted in a similar rate of adverse events compared to patients without prosthesis (HR 0.73).
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