Author + information
- Kishore J. Harjai,
- Eugenia Hopkins,
- Vernon Mascarenhas,
- Samuel Crockett,
- Deepak Singh,
- Russell Stahl,
- Thomas J. Bules,
- Lori Scalzo and
- Pugazhendhi Vijayaraman
Background: Patients who undergo transcatheter aortic valve replacement (TAVR) and have atrial fibrillation (AF) are at high risk of stroke, major bleeding and death due to their age and comorbidities. Left atrial appendage closure (LAAC) devices are now available as alternatives to chronic anticoagulation (AC) for stroke prevention. We performed this single-center study to assess suitability for LAAC in the TAVR population.
Methods: We reviewed the records of 113 consecutive patients who underwent TAVR for severe symptomatic AS with high- or extreme-surgical risk. In the 97 survivors, AF was present in 38 (40%). We estimated the CHADSVASc score, HAS-BLED score and presence of approved indications for LAAC.
Results: Baseline characteristics of 113 pts: age 81 years; female 54%; STS 6.8; surgical risk: high 84%, extreme 16%; follow-up duration 321 days. Patients with AF were similar to those without AF in age, sex and STS score. The median CHADSVASc score of AF patients was 4 (range 1-7). CHADSVASC >3 was seen in 36 (95%). The median HAS-BLED score was 4 (range 2-7). HASBLED >4 was seen in 22 (58%). Stroke prevention strategies included warfarin in 31 (82%), newer AC in 1 (3%), aspirin in 25 (66%), P2Y12 inhibitors in 2 (5%), combined AC and antiplatelet agent in 23 (61%). An approved indication for LAAC was present in 24 (63%) pts [history of major bleeding in 11 (29%); labile INR in 19 (50%); or both in 6 (16%)]. Among 23 patients at high risk for bleeding [due to history of major bleeding in 11 (29%); HASBLED >4 in 22 (58%); or both in 10 (26%)], chronic AC was used in 18 (78%).
Conclusions: Nearly two-thirds of pts with TAVR and AF have an approved indication for LAAC. This need stems from their high risk for stroke as well as bleeding. Despite availability of LAAC devices, most such pts are treated with chronic AC, often combined with antiplatelet agents. Our findings suggest an unmet need for LAAC in this population.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: TAVR 3
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1243-184
- 2017 American College of Cardiology Foundation