Key result
Concomitant M-TEER and LAAC shows no composite outcome benefit over isolated M-TEER at 1 year.
Why the study?
Concomitant M-TEER and LAAC has shown feasibility in eligible patients, but mid-term outcomes remain unclear.
Does concomitant M-TEER and LAAC reduce the composite of death, stroke, HF hospitalization, and bleeding compared to isolated M-TEER in patients with severe MR and AF?
Cohort (n=99)
No
Does concomitant M-TEER and LAAC reduce the composite of death, stroke, HF hospitalization, and bleeding compared to isolated M-TEER in patients with severe MR and AF?
Combining M-TEER and LAAC in a single procedure is safe, technically feasible, and reduces mid-term minor bleeding compared to M-TEER alone in patients with both MR and AF.
Answers are grounded in this paper and cite their sources.
Concomitant M-TEER and LAAC was associated with less minor bleeding and similar events; hypothesis-generating and should not yet change practice.
Background: Concomitant mitral transcatheter edge-to-edge repair (M-TEER) and left atrial appendage closure (LAAC) showed to be a feasible approach to optimize the treatment of patients eligible for both procedures, but mid-term outcomes are unclear. Methods: We retrospectively analyzed consecutive patients undergoing M-TEER and enrolled in the local prospective Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) registry. We compared patients undergoing isolated M-TEER (n = 58, 58.5%) with those undergoing concomitant M-TEER and LAAC (n = 41, 41.5%) from January 2018 to December 2022. The primary endpoint was a composite of all-cause death, stroke or systemic embolism, hospitalization for heart failure, and bleeding at 1 year. The co-primary endpoint was procedural success. Results: The primary endpoint was similar between patients undergoing concomitant M-TEER+LAAC or isolated M-TEER (Kaplan Meier (KM) estimates 36.6% vs. 44.8%; plog-rank = 0.75). Procedural success was also similar (92.7% vs. 94.8%; p = 0.69). At 1- year, minor bleeds were lower in patients undergoing concomitant M-TEER and LAAC (KM estimates 0.0% vs. 18.9%; plog-rank < 0.01). Conclusion: In patients with concomitant MR and AF and eligible for M-TEER and LAAC treatment, a combined approach of M-TEER and LAAC was as safe as an M-TEER-alone strategy and associated with lower minor bleeding at 1 year.
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Frazzetto et al. (2023) conducted a cohort in Severe mitral regurgitation and atrial fibrillation (n=99). Concomitant mitral transcatheter edge-to-edge repair (M-TEER) and left atrial appendage closure (LAAC) vs. Isolated M-TEER was evaluated on Composite of all-cause death, stroke or systemic embolism, hospitalization for heart failure, and bleeding at 1 year (p=0.75). Concomitant M-TEER and LAAC yielded a similar rate of the primary composite endpoint compared to isolated M-TEER but reduced minor bleeding at 1 year.
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