Up-to-date review on concomitant mitral transcatheter edge-to-edge repair and left atrial appendage occlusion - Review

Sep 29, 2026

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In patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER), atrial fibrillation is a common comorbidity. Oral anticoagulation is the main strategy for stroke prevention, yet concomitant left atrial appendage occlusion (LAAO) offers an alternative that can reduce long-term stroke and major bleeding risk. However, upfront periprocedural risk persists, and evidence on the safety and feasibility of performing M-TEER and LAAO together remains limited. This up-to-date narrative review summarizes current literature, procedural considerations, and key unanswered research questions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Left atrial appendage occlusion

Atrial fibrillation burden and stroke mechanism

Anticoagulation options and residual risk

Role of left atrial appendage thrombus

Rationale for occlusion and evidence background

FUTURE CARDIOLOGY 2026, VOL. 22, NO. 1, 65–73 [https://doi.org/10.1080/14796678.2025.2543184](https://doi.org/10.1080/14796678.2025.2543184) REVIEW Up-to-date review on concomitant mitral transcatheter edge-to-edge repair and left atrial appendage occlusion Graeme Prosperi-Portaa, Abdullah Al-Abchab, Trevor Simardb, Benjamin Hibbertb and Omar Abdel-Razeka aDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada; bDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, USA ABSTRACT In patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER), atrial fibrillation is a common comorbidity. While oral anticoagulation is the mainstay of stroke prevention therapy inmost patients with atrial fibrillation, patients undergoing M-TEER might have a unique opportunity to undergo concomitant left atrial appendage occlusion (LAAO) . LAAO is an alternative to oral anticoagulation that reduces the long-term risk of stroke and major bleeding, but it comes with upfront periprocedural risk. M-TEER and LAAO share numerous procedural characteristics including large-bore venous access, transseptal puncture, general anesthesia, and real-time imaging of the left atrium with echocardiography. Therefore, performing concomitant LAAO at the time of M-TEER might be an attractive option for patients to lessen the cumulative peri-procedural risk, repeated anesthetic, and hospital visits from separate procedures. With rapidly evolving device technologies and an increasing evidence base for LAAO use, there is still limited data evaluating the safety and feasibility of concomitant M-TEER and LAAO. This up-to-date narrative review on concomitant M-TEER and LAAO aims to summarize the current body of literature, review practical procedural considerations, and review the unmet research questions limiting the widespread adoption of this concomitant intervention. PLAIN LANGUAGE SUMMARY Atrial fibrillation is a common abnormal heart rhythm that increases the risk of having a stroke due to blood clots forming in the heart. While most patients receive blood thinners to prevent this, some undergo a procedure called a left atrial appendage occlusion (LAAO) which blocks the location where most blood clots form in the heart, avoiding the need for blood thinners. Mitral regurgitation is a common heart valve condition where blood leaks backwards through the mitral valve causing shortness of breath and if untreated can cause the heart muscle to weaken. Some patients with mitral regurgitation can be treated with a minimally invasive procedure called a transcatheter mitral valve edge-to-edge repair (M-TEER) . This procedure repairs the mitral valve by clipping the valve back together, preventing blood from leaking backwards. Approximately half of all patients undergoing M-TEER also have atrial fibrillation. M-TEER and LAAO share similar procedural characteristics including how the devices are delivered into the heart, and the techniques used to guide them into position. Given these similarities, doing both procedures at once is an attractive option for patients to reduce the cumulative procedural risk, repeated anesthetic, and hospital visits required for separate procedures. However, there is limited data confirming the safety and effectiveness of doing both M-TEER and LAAOat the same time. In this review, we summarize the available data on performing M-TEER and LAAO together, review the practical procedural considerations, and look ahead at the unmet research questions limiting the widespread adoption of combining these procedures. ARTICLE HISTORY Received 22 May 2025 Accepted 31 July 2025 KEYWORDS Mitral regurgitation; atrial fibrillation; transcatheter edge-to-edge repair; left atrial appendage occlusion; concomitant intervention 1. Left atrial appendage occlusion Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting more than 59 million individuals and it is the sixth leading ca

FAQs

Why is left atrial appendage occlusion considered alongside M-TEER in atrial fibrillation patients?

Because LAAO targets the main site of thrombus formation in atrial fibrillation and can reduce long-term stroke and major bleeding risk. Doing it concurrently with M-TEER may also lessen cumulative procedural risk and the need for repeated anesthesia and separate hospital visits.

What procedural similarities support combining M-TEER and LAAO?

Both procedures share characteristics such as large-bore venous access, transseptal puncture, general anesthesia, and real-time left atrial imaging with echocardiography.

What limitation motivates further research on concomitant M-TEER and LAAO?

Limited data exist on the safety and feasibility of performing both interventions at the same time, despite rapidly evolving device technologies and a growing evidence base for LAAO.

Sep 29, 2026

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