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 Guerios; Ignacio 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; Francesco Giannini; Máximo Rivero-Ayerza; Shazia Afzal; Christian Jung; Carsten Skurk; Martin Langel; Mark Spence; Evgeny Merkulov; Mathieu Lempereur; Seung Y Shin; Jules Mesnier; Heather L McKinney; Brian T Schuler; Sebastien Armero; Livia Gheorghe; Marco B M Ancona; Lino Santos; Jacques Mansourati; Luis Nombela-Franco; Francesco Nappi; Michael Kühne; Achille Gaspardone; Jesper van der Pals; Matteo Montorfano; Juan Fernández-Armenta; James E Harvey; Josep Rodés-Cabau; Norbert Klein; Sajjad A Sabir; Jung-Sun Kim; Stephane Cook; Ran Kornowski; Antti Saraste; Jens E Nielsen-Kudsk; Dhiraj Gupta; Lucas Boersma; Lorenz Räber; Kolja Sievert; Horst Sievert; Stefan Bertog

doi:10.1016/j.carrev.2024.02.014

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

Authors: 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 Guerios ; Ignacio 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 ; Francesco Giannini ; Máximo Rivero-Ayerza ; Shazia Afzal ; Christian Jung ; Carsten Skurk ; Martin Langel ; Mark Spence ; Evgeny Merkulov ; Mathieu Lempereur ; Seung Y Shin ; Jules Mesnier ; Heather L McKinney ; Brian T Schuler ; Sebastien Armero ; Livia Gheorghe ; Marco B M Ancona ; Lino Santos ; Jacques Mansourati ; Luis Nombela-Franco ; Francesco Nappi ; Michael Kühne ; Achille Gaspardone ; Jesper van der Pals ; Matteo Montorfano ; Juan Fernández-Armenta ; James E Harvey ; Josep Rodés-Cabau ; Norbert Klein ; Sajjad A Sabir ; Jung-Sun Kim ; Stephane Cook ; Ran Kornowski ; Antti Saraste ; Jens E Nielsen-Kudsk ; Dhiraj Gupta ; Lucas Boersma ; Lorenz Räber ; Kolja Sievert ; Horst Sievert ; Stefan Bertog

Citation: CARDIOVASCULAR REVASCULARIZATION MEDICINE, Vol.64 : 7-14, 2024-07

Journal Title: CARDIOVASCULAR REVASCULARIZATION MEDICINE

ISSN: 1553-8389

Issue Date: 2024-07

MeSH: Aged ; Aged, 80 and over ; Atrial Appendage* / diagnostic imaging ; Atrial Appendage* / physiopathology ; Atrial Fibrillation* / mortality ; Atrial Fibrillation* / therapy ; Cardiac Catheterization* / adverse effects ; Cardiac Catheterization* / instrumentation ; Cardiac Catheterization* / mortality ; Device Removal* / adverse effects ; Embolism / etiology ; Embolism / mortality ; Female ; Humans ; Left Atrial Appendage Closure ; Male ; Middle Aged ; Registries* ; Retrospective Studies ; Risk Factors ; Septal Occluder Device ; Time Factors ; Treatment Outcome

Keywords: Atrial fibrillation ; Device embolization ; Left atrial appendage closure ; Occluder embolization ; Retrieval strategy ; Stroke prevention

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.