Percutaneous left atrial appendage occlusion in mitral valve disease: A nationwide readmission database analysis

Rafey Feroze; Waqas Ullah; Puneet Kang; Tabitha Lobo; Nawaf Alhabdan; Mohammed Alghammass; Sung-Han Yoon; Luis Augusto Palma Dallan; Steven J Filby

doi:10.1016/j.carrev.2024.01.007

Percutaneous left atrial appendage occlusion in mitral valve disease: A nationwide readmission database analysis

Cardiovasc Revasc Med. 2024 Jan 15:S1553-8389(24)00008-3. doi: 10.1016/j.carrev.2024.01.007. Online ahead of print.

Authors

Rafey Feroze¹, Waqas Ullah², Puneet Kang³, Tabitha Lobo³, Nawaf Alhabdan³, Mohammed Alghammass¹, Sung-Han Yoon⁴, Luis Augusto Palma Dallan¹, Steven J Filby⁵

Affiliations

¹ Division of Cardiology, University Hospitals, Cleveland, OH, United States of America.
² Department of Cardiology, Thomas Jefferson Hospitals, Philadelphia, PA, United States of America.
³ Division of Internal Medicine, University Hospitals, Cleveland, OH, United States of America.
⁴ Division of Cardiology, University Hospitals, Cleveland, OH, United States of America; Structural and Congenital Heart Center, Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, NJ, United States of America.
⁵ Division of Cardiology, University Hospitals, Cleveland, OH, United States of America. Electronic address: Steven.Filby@UHHospitals.org.

PMID: 38267285
DOI: 10.1016/j.carrev.2024.01.007

Abstract

Background: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a non-pharmacologic alternative to oral anticoagulation in reducing stroke risk in AF patients. However, patients with mitral valve disease (MVD), who are expected to have a significantly greater risk of left atrium (LA) thrombus formation and embolic stroke were excluded from randomized trials examining percutaneous LAAO. To address this gap, we present a national registry analysis of the use of LAAO among patients with MVD.

Methods: Using the National Readmissions Database, we performed a retrospective review of all hospitalizations for LAAO identified between September 2015 and November 2019. Of these, patients with ICD-10 codes for MVD were identified. Propensity matched (PSM) analysis was used to compare patients with MVD with a matched sample of patients undergoing LAAO with non-valvular AF. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion (PE), and tamponade.

Results: 51,540 patients who underwent LAAO without a history of MVD and 3777 with a history of MVD were identified. Crude analysis demonstrated the odds of mortality, PE, and cardiac tamponade during index hospitalization to be higher in the MVD group. The length of stay and cost of index hospitalization were also slightly greater for the MVD group. A sample of 7649 patients (MVD: 3777 MVD and no MVD: 3872) were selected for PSM analysis with similar comorbidities across the two groups. In the PSM comparison, MVD was associated with higher risk of PE. The MVD group had a slightly higher rate of readmissions the association with PE remained at 30-day readmission (OR: 2.099 [1.360-3.238], p-value: <0.001).

Conclusion: To our knowledge, this is the first study examining the use of LAAO among MVD patients. Our findings suggest that patients with MVD who underwent LAAO had a higher risk of post-procedural PE without an increase in mortality, stroke, or major bleeding. These results provide a rationale for considering LAAO as part of the stroke prevention strategy among patients with valvular AF.

Keywords: Left atrial appendage occlusion; Mitral valve; Pericardial effusion; WATCHMAN.