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Published on: February 26, 2013
Percutaneous retrieval of a dislocated LAmbre left atrial appendage occluder in a canine model
Guangji Wang1,2,3, Bin Kong1,2,3, Yu Liu1,2,3
1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
Insights
Retrieving dislocated LAmbre left atrial appendage (LAA) occluders is feasible. However, dislocation into the left ventricle or aorta can lead to serious complications, necessitating careful monitoring during retrieval.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Dislocation of left atrial appendage (LAA) occluders, particularly the LAmbre device, presents retrieval challenges.
- Percutaneous retrieval is possible for embolized devices in the left atrium (LA), aorta (AO), or left ventricle (LV).
Purpose of the Study:
- To investigate the outcomes and feasibility of retrieving a dislocated LAmbre LAA occluder.
Main Methods:
- LAmbre LAA occluders were implanted in 16 healthy dogs.
- Devices were intentionally released in the LA to simulate dislocation.
- Retrieval was performed using percutaneous intervention with grasping forceps.
- Transesophageal echocardiography (TEE) and angiography monitored device position.
Main Results:
- Successful implantation was achieved in all 16 dogs (100% success rate).
- Dislocated devices were found in the LA (50%), AO (31%), and LV (19%).
- One death occurred due to cardiogenic shock after LV dislocation; two aortic valve injuries occurred during LV retrieval.
Conclusions:
- Percutaneous retrieval of dislocated LAmbre LAA occluders is generally feasible.
- Dislocation into the LV or AO poses significant risks of potentially lethal complications.
Background:
Dislocated left atrial appendage (LAA) occluders can be retrieved by percutaneous intervention when performing device embolization into the left atrium (LA), aorta (AO), or left ventricle (LV). However, few reports exist regarding LAmbre LAA occluder dislocation.
Objective:
The study was aimed to explore the outcome of retrieving dislocated LAmbre LAA occluder.
Methods:
Sixteen healthy dogs received LAmbre implants. After implantation of an occlusion device (not released), the occlusion device was completely retrieved. Subsequently, the device was released in the LA, resulting in the dislocation of the device. Angiography and transesophageal echocardiography (TEE) were performed to check the occluders position. Disposable grasping rat-tooth forceps were used to percutaneously retrieve the LAA occluder.
Results:
All the 16 dogs were successfully implanted with the LAmbre LAA occluder and the success rate was 100%. After the occluder was released, TEE and angiography confirmed that the device was located in the LA in eight cases (50%), in the AO in five cases (31%), and in the LV in three cases (19%). One subject died due to cardiogenic shock before the retrieval procedure was complete as the device fell into the LV. Two cases of device-related aortic valve injury occurred during the retrieval procedure when the device was located in the LV. No complications were observed when the device was located in the LA or AO.
Conclusions:
Device retrieval is feasible in most cases. However, potentially lethal complications may occur once the device is dislocated into the LV/AO.
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