Percutaneous closure of left atrial appendage after transcatheter aortic valve implantation - an interventional approach to avoid anticoagulation therapy in elderly patients: TAVI and closure of LAA to avoid warfarin therapy

Bogunović, Nikola; Scholtz, Werner; Prinz, Christian; Faber, Laura M.; Horstkotte, Dieter; F, van Buuren

doi:10.4244/eijv7i11a213

Cited by 20 publications

(5 citation statements)

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“…TAVR should be implanted first, followed by the occlude device to prevent the Amplatzer occluder from potentially being dislodged by the stent of the TAVR. The use of combined structural interventional procedures may offer potential benefits of outcomes and cost savings …”

Section: Discussionmentioning

confidence: 99%

Transcatheter Closure of Atrial Septal Defect with Attenuated Anterior Rim after Transcatheter Aortic Valve Implantation: Can It Be Carried out as a Single Procedure?

et al. 2015

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Transcatheter aortic valve replacement (TAVR) has emerged as a highly effective minimally invasive treatment for symptomatically critical aortic stenosis (AS) in patients at high or prohibitive surgical risk. We report a case of staged transcatheter management of critical AS combined with an atrial septal defect (ASD) with attenuated anterior superior rim. The clinical result of this case suggests that both procedures can be safely performed simultaneously. Therefore, combined transcatheter treatment may appear as a possible strategy in patients with concomitant cardiac conditions.

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Section: Discussionmentioning

confidence: 99%

Transcatheter Closure of Atrial Septal Defect with Attenuated Anterior Rim after Transcatheter Aortic Valve Implantation: Can It Be Carried out as a Single Procedure?

et al. 2015

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“…There is only one statement for 2 cases of having AF along with either AS and no thrombus in LAA. As there were warfarin contraindication in these cases TAVI and LAA shut down process was applied in one to be within the same session and in the other one to be in different sessions [13,14]. Since there was no warfarin contraindication in our cases, after the process was successfully finished the follow-ups continued under the treatment of warfarin.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation in Patients With Left Atrial Appendix Thrombus

et al. 2014

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Aim. The transcatheter aortic valve implantation (TAVI) which developed in the recent years has become an alternative for surgery. However, in spite of new developments the process based vascular and neurological complications still remain to be a problem with elderly patients who also tend to have many co-morbid conditions. With this study we aimed to evaluate the TAVI efficacy and reliability on patients with scarcely relative contraindication and with intracardiac thrombus who are mostly left out of the study. Methods and Results. There has been a successful TAVI process conducted in our clinic for antiplatelet and anticoagulation for 6 cases in which thrombus was seen in left atrial appendix (LAA) via transesophageal echocardiography (TEE) and which are not suitable for surgical valve replacement due to atrial fibrillation (AF) and severe AS comorbid reasons. Edwards SAPIEN XT valve was implanted to all patients transfemorally with general anaesthesia. The process was facilitated successfully and no major/minor stroke was observed in post-process early period, and 9 month controls, in average. Conclusion. Other than AS, also AF, whose frequency increases with age, is an important risk factor for neurological complications. In patients who has AF and AS the source of the cardioembolic focus is mainly LAA. The post-TAVI antiplatelet and anticoagulation treatment is not clear for these patients. We tried to show that TAVI process is reliable in terms of the risk of stroke, in careful processing and suitable anticoagulation treatment for the patients with AF, AS and LAA in this first case study in literature, as far as we know. Цель. Транскатетерная имплантация аортального клапана (ТИАК), которая развивалась в последние годы, стала альтернативой для хирургии. Однако, несмотря на новые разработки, сосудистые и неврологические осложнения, лежащие в основе процесса, по-прежнему остаются проблемами у пожилых пациентов, которые, как правило, имеют много сопутствующих заболеваний. В данном исследовании мы стремились оценить эффективность и надеж-ность ТИАК у пациентов с опасными противопоказаниями и с внутрисердеч-ными тромбами, которые в большинстве случаев не включаются в исследо-вания. Методы и Результаты. Имелись успешные ТИАК, проведенные в нашей кли-нике для антитромбоцитарного и антикоагулянтного лечения 6 случаев, в которых тромб был замечен в ушке левого предсердия (LAA) с помощью чреспищеводной эхокардиографии, и которые являются не пригодными для выполнения хирургической операции по замене клапана вследствие фибрил-ляции предсердий (ФП) и тяжелого стеноза аорты (СА). Клапан Edwards SAPIEN XT был имплантирован всем пациентам трансфеморально под общей анестезией. Процесс был успешно проведен и не было отмечено большого/ малого инсульта в раннем пост-операционном периоде, а также во время 9-месячного контроля, в среднем. Заключение. СА, как и ФП, чья частота увеличивается с возрастом, являются важным фактором риска развития неврологических осложнений. У пациентов, которые уже имеют ФП и СА, кардиоэмболический ...

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“…For the patients with an increased bleeding risk, the left atrial appendage occlusion may be an alternative to OAC. The best candidates could be those with chronic AF, contraindications to OAC or a high risk of drug–drug interaction, and high bleeding risk, like patients with coronary artery stenting that need concomitant DAPT with the risk of prolonged triple therapy (35, 36). This approach has been demonstrated to be safe in recent small series (35, 36).…”

Section: Post-procedural Antithrombotic Therapy For Tavr Patients Witmentioning

confidence: 99%

Antithrombotic Therapy in Transcatheter Aortic Valve Replacement

Valvo

Costa

Tamburino

et al. 2019

Front. Cardiovasc. Med.

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Transcatheter aortic valve replacement (TAVR) has recently emerged as an effective alternative to medical treatment or surgical aortic valve replacement in all symptomatic patients with severe aortic stenosis and high or prohibitive risk and in intermediate risk when transfemoral access is feasible. Patients undergoing TAVR are often at high risk for either bleeding or cerebrovascular complications, or both, so adjuvant antithrombotic therapies are commonly used before, during and after the procedure. Today, there is no clear evidence on the best antithrombotic regimen in this context. In this review, we will try to go through the mechanisms involved in bleeding and embolic complications and we will discuss the current points of antithrombotic treatment in patients during and after TAVR, with or without oral anticoagulation (OAC) indication.

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Percutaneous closure of left atrial appendage after transcatheter aortic valve implantation - an interventional approach to avoid anticoagulation therapy in elderly patients: TAVI and closure of LAA to avoid warfarin therapy

Cited by 20 publications

References 4 publications

Transcatheter Closure of Atrial Septal Defect with Attenuated Anterior Rim after Transcatheter Aortic Valve Implantation: Can It Be Carried out as a Single Procedure?

Transcatheter Closure of Atrial Septal Defect with Attenuated Anterior Rim after Transcatheter Aortic Valve Implantation: Can It Be Carried out as a Single Procedure?

Transcatheter Aortic Valve Implantation in Patients With Left Atrial Appendix Thrombus

Antithrombotic Therapy in Transcatheter Aortic Valve Replacement

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