Many patients with aortic stenosis have now been able to receive transcatheter aortic valve replacement (TAVR). In addition, patients with atrial fibrillation have also been able to receive left atrial appendage (LAA) occlusion for prevention of stroke. According to current studies and guidelines, LAA closure is indicated in patients with non-valvular atrial fibrillation. However, what happens if the valvular disease is treated and the atrial fibrillation persists? Can LAA closure help modify the risk of stroke in patients with aortic stenosis that receive TAVR? This query brings up issues of prevalence, indication, procedural safety and long-term outcomes.
The patients under discussion are those with aortic stenosis who are at risk for stroke due to atrial fibrillation. The Placement of Aortic Transcatheter Valves (PARTNER) trial reported one-year stroke data as 8.3 % in cohort A (high-risk operable) patients1 and 10.6 % in cohort B (non-operable) patients.2 Other registry data show that 30-day stroke risk was present in multiple registries (periprocedural stroke risk of 1.5 %, 30-day stroke rate of 4.0 %, with 30-day major stroke risk of 3.2 % and 30-day minor stroke risk of 1.0 %).3,4 Yet other studies indicate that roughly half of strokes within the first 30 days will be periprocedural, and half will be after the procedure.5–7