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

• DOI: 10.1016/j.carrev.2024.02.014
• Publication Date: 2024-02-28T02:08:42Z
• 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 Sch...; Nicolas Amabile; Kasper Korsholm; Juha Lund; Enio Guerios; Ignacio J. Amat-S...; 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...; Andrea Natale; Ole de Backer; Joelle Kefer; Pablo P. Esteban; Mark Abelson; Pradhum Ram; Pamela Moceri; Jose G. Galache O...; Xavier Millán Alv...; Ignacio Cruz-Gonz...; 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-Ar...; James E. Harvey; Josep Rodés-Cabau; Norbert Klein; Sajjad A. Sabir; Jung-Sun Kim; Stephane Cook; Ran Kornowski; Antti Saraste; Jens E. Nielsen-K...; Dhiraj Gupta; Lucas Boersma; Lorenz Räber; Kolja Sievert; Horst Sievert; Stefan Bertog
• Keywords: Stroke

Left atrial appendage (LAA) occluder embolization is an infrequent but serious complication.We aim to describe timing, management and clinical outcomes of device embolization in a multi-center registry.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.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.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.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.