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Updated: Feb 27, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Combined MitraClip implantation and left atrial appendage occlusion using the Watchman device: A case series from a
Ana Rita G Francisco1, Eduardo Infante de Oliveira1, Miguel Nobre Menezes1
1Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Insights
Combining MitraClip implantation and left atrial appendage occlusion is a feasible, safe, and effective single-procedure approach for high-risk patients with atrial fibrillation and mitral regurgitation. This combined treatment significantly improves clinical outcomes and reduces mitral regurgitation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Patients undergoing MitraClip implantation often have atrial fibrillation, necessitating oral anticoagulation.
- Left atrial appendage occlusion (LAAO) is a safe alternative to anticoagulation for stroke prevention in atrial fibrillation.
- Concomitant percutaneous procedures like MitraClip and LAAO are technically appealing.
Purpose of the Study:
- To assess the feasibility of combining MitraClip implantation and LAAO in a single procedure.
- To explore the safety and efficacy of this combined approach.
Main Methods:
- A case series of five patients undergoing simultaneous LAAO with Watchman device and MitraClip implantation.
- Evaluation of procedural success, complications, mitral regurgitation reduction, and clinical improvement.
Main Results:
- Successful combined procedure in all five patients.
- Significant reduction in mitral regurgitation (≥2 grades) and improvement in NYHA functional class (≥1 class).
- Optimal device placement and no procedural complications observed.
Conclusions:
- Combined MitraClip implantation and LAAO is feasible, safe, and effective in selected patients.
- This approach offers a valuable treatment option for patients with atrial fibrillation, severe mitral regurgitation, and high bleeding/embolic risk.
- The single-procedure strategy simplifies treatment and improves patient outcomes.
Introduction:
Patients referred for percutaneous transcatheter mitral valve repair using the MitraClip® system frequently have atrial fibrillation, which imposes additional challenges due to the need for oral anticoagulation. Left atrial appendage occlusion is currently regarded as a non-inferior alternative to anticoagulation in patients with non-valvular atrial fibrillation and both high thromboembolic and bleeding risk. Considering that both MitraClip implantation and left atrial appendage occlusion are percutaneous techniques that require transseptal puncture, it is technically attractive to consider their concomitant use.
Objectives:
We aim to evaluate the feasibility of a combined approach with MitraClip implantation and left atrial appendage occlusion in a single procedure.
Methods:
We report the first case series regarding this issue, discussing the specific advantages, pitfalls and technical aspects of combining these two procedures.
Results:
Five patients underwent left atrial appendage occlusion with the Watchman® device followed by MitraClip implantation in the same procedure. All patients experienced significant reduction in mitral valve regurgitation of at least two grades, optimal occluder position, no associated complications and significant clinical improvement assessed by NYHA functional class (reduction of at least one functional class, with four patients in class I at one-month follow-up).
Conclusion:
In selected patients rejected for surgical mitral valve repair, with atrial fibrillation and increased risk of bleeding and embolic events, a combined approach with MitraClip implantation and left atrial appendage occlusion in a single procedure is feasible, safe and effective.
