Concomitant Mitral Transcatheter Edge-to-Edge Repair and Left Atrial Appendage Closure in Patients With Atrial Fibrillation and High Bleeding Risk

Evidence on concomitant mitral transcatheter edge-to-edge repair (M-TEER) and left atrial appendage closure (LAAC) is limited. This retrospective registry compared 216 isolated M-TEER procedures with 133 concomitant procedures at 13 centers. The primary endpoint was cardiovascular death, stroke or transient ischemic attack, or site-reported major bleeding through 24 months. Analyses used Kaplan-Meier estimates, center-clustered Cox models, and overlap weighting. Median follow-up was 21.5 months after isolated and 9.2 months after concomitant treatment. The primary endpoint occurred in 41 (19.0%) and 16 (12.0%) patients, respectively; 24-month event-free survival was 73.8% and 80.1%. The adjusted hazard ratio was 0.79 (95% confidence interval 0.50-1.25), and the expanded overlap-weighted estimate was 0.79 (0.49-1.28). Overlap-weighted estimates with follow-up truncated at 9 and 12 months were 1.02 (0.56-1.83) and 0.91 (0.50-1.63). Results were sensitive to exclusion of patients with reconstructed event dates. Oral anticoagulation at discharge was prescribed in 187/202 (92.6%) evaluable isolated-procedure patients and 20/133 (15.0%) concomitant-procedure patients; standardized longitudinal medication assessments were unavailable. In conclusion, concomitant M-TEER and LAAC was feasible and associated with less anticoagulant prescription at discharge, but nonrandom allocation, unequal follow-up, incomplete bleeding classification, and uncertain event timing prevent conclusions regarding comparative clinical benefit.