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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Embolization of percutaneous left atrial appendage closure devices: Timing, management and clinical outcomes
Sophie Eppinger1, Kerstin Piayda2, Roberto Galea3
1CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany.
Insights
Left atrial appendage (LAA) occluder embolization is a serious complication, often occurring early. Percutaneous retrieval is the preferred first attempt, but repeat attempts significantly increase mortality risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Complications
Background:
- Left atrial appendage (LAA) occluder device embolization is an infrequent yet serious complication.
- Understanding the timing, management, and outcomes of LAA occluder embolization is crucial for patient safety.
Purpose of the Study:
- To describe the timing, management strategies, and clinical outcomes of LAA occluder device embolization.
- To analyze the effectiveness and risks associated with different retrieval methods for embolized LAA devices.
Main Methods:
- Retrospective data collection from a multi-center registry.
- Inclusion of patient characteristics, imaging findings, procedural details, and follow-up data.
- Categorization of device embolizations by timing, management, and clinical outcomes.
Main Results:
- Device embolization occurred in 108 patients across 67 centers, with 70.4% happening within 24 hours.
- Percutaneous retrieval was the initial approach in 75.0% of cases; surgery was performed in 21.3%.
- High mortality rates were observed, particularly after unsuccessful first retrieval attempts and subsequent second attempts (21.4% vs. 2.9%).
Conclusions:
- The majority of LAA occluder embolizations occur early post-procedure.
- While percutaneous retrieval is the preferred first-line management, repeat attempts are associated with significantly higher mortality.
- High rates of major adverse events, including death, underscore the severity of this complication.
Background:
Left atrial appendage (LAA) occluder embolization is an infrequent but serious complication.
Objectives:
We aim to describe timing, management and clinical outcomes of device embolization in a multi-center registry.
Methods:
Patient characteristics, imaging findings and procedure and follow-up data were collected retrospectively. Device embolizations were categorized according to 1) timing 2) management and 3) clinical outcomes.
Results:
Sixty-seven centers contributed data. Device embolization occurred in 108 patients. In 70.4 % of cases, it happened within the first 24 h of the procedure. The device was purposefully left in the LA and the aorta in two (1.9 %) patients, an initial percutaneous retrieval was attempted in 81 (75.0 %) and surgery without prior percutaneous retrieval attempt was performed in 23 (21.3 %) patients. Two patients died before a retrieval attempt could be made. In 28/81 (34.6 %) patients with an initial percutaneous retrieval attempt a second, additional attempt was performed, which was associated with a high mortality (death in patients with one attempt: 2.9 % vs. second attempt: 21.4 %, p < 0.001). The primary outcome (bailout surgery, cardiogenic shock, stroke, TIA, and/or death) occurred in 47 (43.5 %) patients. Other major complications related to device embolization occurred in 21 (19.4 %) patients.
Conclusions:
The majority of device embolizations after LAA closure occurs early. A percutaneous approach is often the preferred method for a first rescue attempt. Major adverse event rates, including death, are high particularly if the first retrieval attempt was unsuccessful.
Condensed Abstract:
This dedicated multicenter registry examined timing, management, and clinical outcome of device embolization. Early embolization (70.4 %) was most frequent. As a first rescue attempt, percutaneous retrieval was preferred in 75.0 %, followed by surgical removal (21.3 %). In patients with a second retrieval attempt a higher mortality (death first attempt: 2.9 % vs. death second attempt: 24.1 %, p < 0.001) was observed. Mortality (10.2 %) and the major complication rate after device embolization were high.
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