The Outcomes of Percutaneous Mitral Balloon Valvuloplasty in Patients With Severe Rheumatic Mitral Stenosis and Left Atrial Appendage Thrombus: Systematic Review and Meta-Analysis.

Persistent left atrial appendage thrombus despite anticoagulation is common. Current guidelines advise against percutaneous mitral balloon valvuloplasty (PMBV) because of perceived thromboembolic risk, leaving surgical mitral valve replacement-an option associated with substantial morbidity-as the primary alternative. However, the procedural risk of PMBV in the setting of left atrial appendage thrombus remains poorly established. We conducted a systematic review and meta-analysis to assess this. Of the 2,136 studies identified in the initial search, 17 were included in the analysis, comprising 386 patients undergoing PMBV with left atrial appendage (LAA) thrombus. The rate of stroke or embolic complication was 2.8% (95% CI 1.4% to 5.5%). No stroke or embolic complications occurred in Type Ia thrombus. In conclusion, LAA-confined thrombus (Type 1a) was not associated with embolic events, supporting a morphology-based approach to patient selection and emphasizing the need for prospective data to refine the current guidelines.