Key result
Simultaneous TEER and LAA closure successfully reduces mitral regurgitation to grade 1 without early complications.
Why the study?
High surgical risk patients with mitral regurgitation and atrial fibrillation face risks from open surgery and anticoagulation, but data on combining simultaneous endovascular edge-to-edge repair and left atrial appendage closure are lacking.
Does simultaneous endovascular edge-to-edge mitral valve clipping and left atrial appendage closure safely reduce mitral regurgitation and stroke risk in high-risk patients?
Case Report (n=1)
No
Does simultaneous endovascular edge-to-edge mitral valve clipping and left atrial appendage closure safely reduce mitral regurgitation and stroke risk in high-risk patients?
Combining transcatheter mitral valve edge-to-edge repair and left atrial appendage occlusion is a technically feasible and safe option for selected highly comorbid patients with both severe mitral regurgitation and atrial fibrillation.
May support combined mitral clipping and LAA closure in selected high-risk cases; leaves open need for prospective trials on outcomes.
Mitral regurgitation is one of the most common valvular heart diseases, with the gold standard of its treatment being an open surgical intervention. However, it is not always performed in patients with a high surgical risk. Atrial fibrillation is a frequent companion of mitral valve regurgitation. It significantly increases the risk of ischemic strokes and systemic thromboembolism and required the administration of anticoagulants. Long-term use of anticoagulants entails an increased risk of hemorrhagic complications. Surgical endovascular closure of the left atrial appendage allows for reduction of the risks both of embolic and hemorrhagic complications. This paper presents a clinical case of the first in Russia successful simultaneous endovascular remodeling of the mitral valve by edge-to-edge leaflet clipping and closure of the left atrial appendage with an Amplatzer Amulet occluder. This was an 85-year old patient with advanced mitral regurgitation, who was not considered a candidate for an open surgery due to his high surgical risk. The severity of the patients condition was related to atrial fibrillation, rectal cancer and severe anemia. The patient underwent simultaneous sequential clipping of the mitral valve leaflets and closure of the left atrial appendage. Control trans-esophageal echocardiography showed a significant decrease in the mitral regurgitation grade. There were no complications during the hospital stay and in the early postoperative period. The lack of convincing data and research makes it impossible to delineate clear indications and contraindications for the combination of two procedures within one surgical session. However, simultaneous endovascular clipping of the mitral valve leaflets and an occluder implantation into the left atrial appendage may become the method of choice in the treatment of patients with severe mitral valve regurgitation, prevention of embolic and hemorrhagic complications in high risk comorbid patients.
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Semitko et al. (2022) conducted a case report in Severe mitral regurgitation and atrial fibrillation (n=1). Simultaneous transcatheter edge-to-edge mitral valve clipping and left atrial appendage closure was evaluated on Procedural success (reduction in mitral regurgitation grade) and early postoperative complications. Simultaneous endovascular edge-to-edge mitral valve clipping and left atrial appendage closure successfully reduced mitral regurgitation to grade 1 with no early complications.
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