Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes

Sophie Eppinger, Kerstin Piayda, Roberto Galea, Marcus Sandri, Moniek Maarse, Ahmet Güner, Can Y Karabay, Ashish Pershad, Wern Y Ding, Adel Aminian, Ibrahim Akin, Karapet V Davtyan, Ivan A Chugunov, Eloi Marijon, Liesbeth Rosseel, Thomas Robert Schmidt, Nicolas Amabile, Kasper Korsholm, Juha Lund, Enio GueriosIgnacio J Amat-Santos, Giacomo Boccuzzi, Christopher R Ellis, Avi Sabbag, Henning Ebelt, Brian Clapp, Hana Vaknin Assa, Amos Levi, Jakob Ledwoch, Sonja Lehmann, Oh-Hyun Lee, George Mark, Wendy Schell, Domenico G Della Rocca, Andrea Natale, Ole de Backer, Joelle Kefer, Pablo P Esteban, Mark Abelson, Pradhum Ram, Pamela Moceri, Jose G Galache Osuna, Xavier Millán Alvarez, Ignacio Cruz-Gonzalez, Tom de Potter, Moubarak Ghassan, Andrey Osadchiy, Weita Chen, Sandeep K Goyal, Jens E Nielsen-Kudsk

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Abstract

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.

OriginalsprogEngelsk
TidsskriftCardiovascular revascularization medicine : including molecular interventions
Vol/bind64
Sider (fra-til)7-14
Antal sider8
ISSN1553-8389
DOI
StatusUdgivet - jul. 2024

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