LEFT ATRIAL APPENDAGE CLOSURE IN PATIENTS WITH MECHANICAL MITRAL VALVE PROSTHESIS : A MULTICENTER ITALIAN PILOT STUDY
Copyright © 2024 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved..
INTRODUCTION: 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 underwent LAAC because of thrombotic events including TIA/stroke, systemic embolism and evidence of left atrial appendage thrombosis/sludge despite VKA therapy were enrolled. Patients with mechanical PMV were included and compared with those affected by non valvular AF. 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: 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 carriers of mechanical PMV with failure of VKA therapy. This off-label, real-world clinical practice indication deserve validation in further studies.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
The Canadian journal of cardiology - (2024) vom: 14. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Preda, Alberto [VerfasserIn] |
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| Links: |
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| Themen: |
Antithrombotic therapy |
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| Anmerkungen: |
Date Revised 16.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.cjca.2024.01.039 |
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| Förderinstitution / Projekttitel: |
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| 520 | |a Copyright © 2024 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a INTRODUCTION: 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 | ||
| 520 | |a METHODS: In this retrospective, multicenter study, patients underwent LAAC because of thrombotic events including TIA/stroke, systemic embolism and evidence of left atrial appendage thrombosis/sludge despite VKA therapy were enrolled. Patients with mechanical PMV were included and compared with those affected by non valvular AF. 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 | ||
| 520 | |a RESULTS: 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]) | ||
| 520 | |a CONCLUSION: LAAC seems to be a valuable alternative in AF carriers of mechanical PMV with failure of VKA therapy. This off-label, real-world clinical practice indication deserve validation in further studies | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a antithrombotic therapy | |
| 650 | 4 | |a atrial fibrillation | |
| 650 | 4 | |a left atrial appendage closure | |
| 650 | 4 | |a mechanical mitral valve prosthesis | |
| 650 | 4 | |a stroke | |
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| 700 | 1 | |a Marzi, Alessandra |e verfasserin |4 aut | |
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