Left atrial appendage perforation with Watchman device implantation: Strategies for surgical repair

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Percutaneous left atrial appendage (LAA) occlusion is a growing alternative to anticoagulation for stroke prevention in non-valvular atrial fibrillation (NVAF).
• Patients with NVAF often have high risks associated with long-term anticoagulation therapy.
• The Watchman device is a commonly used LAA occlusion device.

Observation:

• A case of left atrial appendage perforation occurred during Watchman device implantation.
• The perforation necessitated immediate surgical intervention.
• Emergency repair of the left atrium was performed using sternotomy and cardiopulmonary bypass.

Findings:

• Left atrial appendage perforation is a serious, albeit rare, complication of Watchman device implantation.
• Prompt surgical intervention is critical for managing this complication.
• The case highlights the importance of surgical preparedness in interventional LAA closure procedures.

Implications:

• This case underscores the need for careful patient selection and procedural technique in LAA occlusion.
• It emphasizes the critical role of surgical backup and expertise for managing potential complications.
• Decision-making for surgical intervention should consider patient hemodynamics and embolic risk.