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An under‐recognized high‐risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application
Author(s) -
Lane Colleen E.,
Eleid Mackram F.,
Holmes David R.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28220
Subject(s) - medicine , atrial fibrillation , stroke (engine) , cardiology , stroke risk , bleed , mitral valve , mitral regurgitation , surgery , ischemic stroke , ischemia , mechanical engineering , engineering
Objective Identify patients undergoing transcatheter mitral valve repair (TMVR) who could potentially benefit from alternative ischemic stroke prophylaxis utilizing a left atrial appendage closure (LAAC) device. Background Patients undergoing TMVR have a high incidence of atrial fibrillation (AF). The co‐morbidities which qualify them to undergo TMVR also increase their risk of stroke and bleeding, making stroke prophylaxis problematic. Methods We conducted a single‐center retrospective study, in which the bleeding and stroke risk of all patients undergoing TMVR for degenerative mitral valve disease were reviewed to determine candidacy for a LAAC device for stroke prevention as an alternative to chronic anticoagulation. Results AF was present in 122 (62%) of TMVR patients with an average CHA2DS2‐VASc score of 3.99. 23% of TMVR patients had a history of prior major bleeding event, predominately gastrointestinal bleed. Fifty‐three and 47% of TMVR patients were at high or intermediate risk of bleeding, respectively, according to their HAS‐BLED score. 50% of patients undergoing TMVR would qualify for LAAC device based on risk assessments. Conclusion Patients undergoing TMVR represent a high risk group of AF patients that may benefit from a LAAC device.