Outcomes of left atrial appendage closure in patients with prior mitral valve interventions

Data on left atrial appendage closure (LAAC) in valvular patients remain limited. This study aimed to evaluate procedural safety and outcomes of LAAC in patients with and without prior mitral valve interventions (PMVI).

Patients who underwent transcatheter LAAC between 2016 and 2023 across high-volume centers in Europe and North America were included. Patients were stratified according to the presence or absence of PMVI (surgical or transcatheter). The primary endpoint was a composite of all-cause mortality and ischemic events (ischemic stroke or systemic embolism) at 2 years.

Among 1,213 consecutive patients, 142 had PMVI. Patients with PMVI had higher rates of chronic heart failure, permanent AF, and lower left ventricular ejection fraction. Disc-lobe devices and combined procedures were more frequently used in the PMVI group. Procedural success was very high in both groups (99.3% in PMVI vs. 99.4%, p = 0.83). Device-related thrombus (DRT) occurred in 6.8% of patients, with no difference between groups (7.0% in PMVI vs. 6.8%, p = 0.92). The cumulative incidence of all-cause mortality or ischemic stroke/systemic embolism at 2 years was similar between groups (21.3% vs. 21.8%, HR 1.14 [95% CI 0.76-1.72], p = 0.53). However, no ischemic stroke events were observed among patients with PMVI (0% vs. 4.6%, p = 0.012). PMVI was independently associated with a higher risk of all-cause mortality at maximum follow-up (adjusted OR 1.76, 95% CI 1.20-2.60; p = 0.004).

LAAC appears feasible and safe in patients with a history of PMVI. Despite a higher baseline risk and a higher adjusted risk of all-cause mortality, rates of ischemic stroke and thromboembolic complications remained low after LAAC.