Safety and efficacy of Watchman extraction using a double transseptal approach

Left atrial appendage occlusion (LAAO) device dislodgment or embolization is a rare but potentially life-threatening complication. Although there is a designated apparatus available for delivery and implantation of these devices, there are no predefined instructions or required equipment available for extraction of a dislodged device.

This multicenter experience aims to provide a detailed description of the Watchman extraction procedure and to evaluate both its success rates and the potential complications.

We analyzed consecutive patients undergoing percutaneous retrieval of Watchman 2.5 or FLX devices at 2 United States centers between 2019 and 2024. Retrieval was attempted via single or double transseptal approach, with a transfabric access if the device was firmly attached to the left atrial appendage ostium. Procedural success was described as complete extraction of Watchman without procedural complication.

10 patients (6 male; 60%) underwent percutaneous retrieval of LAAO devices which were dislodged in 9 (90%) and embolized in 1 (10%). Retrieval procedure was performed within 1 week in 3 patients (30%) and within 3 months in 7 patients (70%). A single transseptal approach was used in 3 patients (30%), with only 1 (33%) successful. Retrieval via double transseptal approach was successful in 7 patients (70%), including 4 (40%) who required transfabric access because of device firmly anchored to the LAA ostium.

Percutaneous Watchman retrieval is technically feasible when performed in highly experienced centers with dedicated equipment and surgical backup. For Watchman FLX devices firmly anchored to the LAA ostium, a transfabric technique can facilitate retrieval.