Left Atrial Appendage Closure in Patients With a Mechanical Mitral Valve Prosthesis: A Multicentre Italian Pilot Study

In patients with atrial fibrillation (AF) on vitamin K antagonist (VKA) therapy and therapeutic international normalized ratio (INR) range, the incidence of cardiac thromboembolism is not negligible, and the subgroup of patients who have 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 with a mechanical PMV who experienced a failure of VKA therapy. In this retrospective, multicentre study, patients underwent LAAC because of thrombotic events including transient ischemic attack and/or stroke, systemic embolism, and evidence of left atrial appendage thrombosis and/or sludge, despite VKA therapy, were enrolled. Patients with a mechanical PMV were included and compared with those affected by nonvalvular AF. The primary endpoint was the composite of all-cause death, major cardiovascular events, and major bleedings at follow-up. The feasibility and safety of LAAC also were assessed. A total of 55 patients (42% female; mean age, 70 ± 9 years), including 12 with a 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 a PMV. In 35 patients, a cerebral protection device was used. During a median follow-up of 6.1 ± 4.3 years, 4 patients with a PMV, and 20 patients without a PMV, reported adverse events (hazard ratio 0.73 [95% confidence interval 0.25-2.16, P = 0.564]). LAAC seems to be a valuable alternative in patients with AF who have a mechanical PMV, with failure of VKA therapy. This off-label, real-world clinical practice indication deserves validation in further studies. Chez les patients atteints de fibrillation auriculaire (FA) sous traitement par antagonistes de la vitamine K (AVK) et avec un rapport international normalisé (RIN) situé dans la plage thérapeutique, l'incidence de la thromboembolie cardiaque n'est pas négligeable, et le sous-groupe de patients porteurs d'une prothèse mécanique de la valve mitrale (PVM) présente le risque le plus élevé. Nous avons cherché à évaluer les effets à long terme de la fermeture de l'auricule gauche (FAG) chez les patients atteints de FA, porteurs d'une PVM mécanique, et dont le traitement par AVK a échoué. Dans cette étude rétrospective multicentrique, les patients ayant subi une FAG en raison d'événements thrombotiques pouvant être un accident ischémique transitoire et/ou u