Successful Percutaneous Extraction of a WATCHMAN FLX Device From the Left Ventricular Outflow Tract

Although rare, embolization of left atrial appendage occlusion (LAAO) devices carries a significant morbidity and mortality burden.

An asymptomatic 77-year-old woman with inability to tolerate anticoagulation due to gastrointestinal bleeding presented for 45-day transesophageal echocardiography following LAAO with a Watchman device, which demonstrated incidental device migration to the left ventricular outflow tract (LVOT). Percutaneous extraction was performed using a novel technique with rat tooth/alligator forceps to successfully retrieve the Watchman from the LVOT using a transaortic approach.

LAAO device embolization is a rare, yet serious, complication. Retrieval from the LVOT is typically performed with cardiac surgery to avoid damage to the mitral valve. This case demonstrates that percutaneous Watchman device retrieval from the LVOT is technically challenging but can be safely performed in select cases to decrease the length of hospitalization and morbidity associated with surgery.