(VP071) LAAOS III SUBSTUDY: ADDITION OF LEFT ATRIAL APPENDAGE OCCLUSION IN AORTIC VALVE CLINIC DISCUSSIONS TO AID IN DECISIONS BETWEEN SAVR AND TAVR IN PATIENTS WITH AORTIC STENOSIS

Background: The choice of proceeding with surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) is based on multiple factors including the surgical risk, patient frailty, comorbid conditions, and patient preferences and values. LAAOS III was a large randomized controlled trial that demonstrated concomitant left atrial appendage occlusion (LAAO) in patients undergoing cardiac surgery for another indication reduces the risk of stroke/systemic embolism (HR 0.67, 95% CI 0.53-0.85, P=0.001). The results specific to patients requiring aortic valve intervention have not been described.

METHODS AND RESULTS: This LAAOS III substudy included 1736 patients from 105 centers in 27 countries in the trial who underwent surgical aortic valve replacement: 856 (49.3%) patients had concomitant LAAO and 880 (50.7%) did not. We defined the primary outcome as the first occurrence of ischemic stroke or type uncertain stroke or systemic arterial embolism over a mean follow-up of 3.8 years, which occurred in 50 participants (2.9%) in the LAAO group and in 79 (4.6%) in the no LAAO group (hazard ratio [HR], 0.64; 95% confidence interval, 0.45 to 0.91; P=0.01). The secondary outcome was the first occurrence of hospital readmission for heart failure during a mean follow-up of 3.8 years, which occurred in 74 (8.6%) in the LAAO group and 59 (6.7%) in the no LAAO group (unadjusted HR, 1.29; 95% CI 0.92-1.81, P=0.15), and the adjusted HR which accounted for sex, age, hypertension, smoking, ablation, CHA2DS2VASc, LVEF grade (adjusted HR, 1.32; 95% CI 0.94-1.86, P=0.11).

Conclusion: The benefit of LAAO on ischemic stroke and systemic embolism was consistent among the subset of patients who underwent surgical aortic valve replacement in LAAOS III. Heart teams and patients should consider these results when deciding between TAVR and SAVR in patients with atrial fibrillation requiring aortic valve replacement.