Surgical removal of occluder devices: complications and pitfalls

Interventional closures of atrial septal defects (ASDs) and paravalvular leaks represent attractive treatment options to prevent surgical procedures. Nevertheless, a small number of complications or pitfalls remain after interventional closure of ASDs or paravalvular leaks that require surgical therapy. We report on 3 cases in which surgery was necessary after attempts to close a paravalvular leak. A mechanical valve prosthesis in the mitral position was explanted from a 73-year-old man because of increasing hemolysis and restriction of the motion of one leaflet by the occluder device. A 21-year-old woman with 3 previous surgeries for truncus arteriosus communis type 1 developed paravalvular leakage after replacements of the pulmonary and aortic valves. Although aortic insufficiency was reduced to grade I by placing 2 Amplatzer occluders, significant hemolysis developed. A 24-year-old woman had previously undergone 3 cardiac surgeries (commissurotomy at the age of 5 years for aortic stenosis, followed by aortic valve replacements at 13 and 14 years of age). The patient developed severe hemolysis after interventional closure. A redo aortic valve replacement was performed for the fourth time. As in the previous 2 cases, the surgery for this challenging case and the postoperative course went well. We also present 6 cases in which the occluder was explanted because of dislocation, thrombus formation, irritation of the aortic root, or systemic allergic reaction to the percutaneous occluder after initial closure of the ASD. The intra- and postoperative courses were uneventful in all cases. In summary, surgery for complications or pitfalls after interventional closure of paravalvular leaks or ASDs is challenging and carries a high risk in cases of paravalvular leaks. Nevertheless, the outcomes of the presented cases were uneventful. In the future, the development of a more suitable device technology may improve the results of interventional procedures, especially in cases of paravalvular leaks.