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

Atrial fibrillation; Device embolization; Left atrial appendage closure; Occluder embolization; Retrieval strategy; Stroke prevention; Humans; Male; Female; Aged; Retrospective Studies; Treatment Outcome; Time Factors; Aged, 80 and over; Risk Factors; Embolism/etiology; Embolism/mortality; Middle Aged; Septal Occluder Device; Left Atrial Appendage Closure; Atrial Appendage/diagnostic imaging; Atrial Appendage/physiopathology; Registries; Cardiac Catheterization/adverse effects; Cardiac Catheterization/instrumentation; Cardiac Catheterization/mortality; Atrial Fibrillation/therapy; Atrial Fibrillation/mortality; Device Removal/adverse effects; Cardiology and Cardiovascular Medicine

Abstract :

[en] [en] 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.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Eppinger, Sophie; CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany

Piayda, Kerstin; CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany, Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany

Galea, Roberto; Department of Cardiology, Universitätsspital Bern, Bern, Switzerland

Sandri, Marcus; Herzzentrum Leipzig, Leipzig, Germany

Maarse, Moniek; Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands

Güner, Ahmet; Department of Cardiology, Mehmet Akif Ersoy Hospital, Istanbul, Turkey

Karabay, Can Y; Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey

Pershad, Ashish; Department of Cardiology, Banner Health, Phoenix, AZ, USA

Ding, Wern Y; Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK

Aminian, Adel; Department of Cardiology, Centre hospitalier universitaire de Charleroi, Charleroi, Belgium

More authors (79 more)

Language :

English

Title :

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

Publication date :

July 2024

Journal title :

Cardiovascular Revascularization Medicine: including Molecular Interventions

ISSN :

1553-8389

eISSN :

1878-0938

Publisher :

Elsevier Inc., United States

Volume :

Pages :

7 - 14

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S1553838924000678?httpAccept=text/xml

Available on ORBi :

since 17 June 2024

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