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Multicenter Study
. 2024 Jul:64:7-14.
doi: 10.1016/j.carrev.2024.02.014. Epub 2024 Feb 28.

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

Sophie Eppinger  1 , Kerstin Piayda  2 , Roberto Galea  3 , Marcus Sandri  4 , Moniek Maarse  5 , Ahmet Güner  6 , Can Y Karabay  7 , Ashish Pershad  8 , Wern Y Ding  9 , Adel Aminian  10 , Ibrahim Akin  11 , Karapet V Davtyan  12 , Ivan A Chugunov  12 , Eloi Marijon  13 , Liesbeth Rosseel  14 , Thomas Robert Schmidt  15 , Nicolas Amabile  16 , Kasper Korsholm  17 , Juha Lund  18 , Enio Guerios  19 , Ignacio J Amat-Santos  20 , Giacomo Boccuzzi  21 , Christopher R Ellis  22 , Avi Sabbag  23 , Henning Ebelt  24 , Brian Clapp  25 , Hana Vaknin Assa  26 , Amos Levi  26 , Jakob Ledwoch  27 , Sonja Lehmann  28 , Oh-Hyun Lee  29 , George Mark  30 , Wendy Schell  31 , Domenico G Della Rocca  32 , Andrea Natale  32 , Ole de Backer  33 , Joelle Kefer  34 , Pablo P Esteban  35 , Mark Abelson  36 , Pradhum Ram  37 , Pamela Moceri  38 , Jose G Galache Osuna  39 , Xavier Millán Alvarez  40 , Ignacio Cruz-Gonzalez  41 , Tom de Potter  42 , Moubarak Ghassan  43 , Andrey Osadchiy  44 , Weita Chen  45 , Sandeep K Goyal  46 , Francesco Giannini  47 , Máximo Rivero-Ayerza  48 , Shazia Afzal  49 , Christian Jung  49 , Carsten Skurk  50 , Martin Langel  51 , Mark Spence  52 , Evgeny Merkulov  53 , Mathieu Lempereur  54 , Seung Y Shin  55 , Jules Mesnier  56 , Heather L McKinney  57 , Brian T Schuler  57 , Sebastien Armero  58 , Livia Gheorghe  59 , Marco B M Ancona  60 , Lino Santos  61 , Jacques Mansourati  62 , Luis Nombela-Franco  63 , Francesco Nappi  64 , Michael Kühne  65 , Achille Gaspardone  66 , Jesper van der Pals  67 , Matteo Montorfano  60 , Juan Fernández-Armenta  59 , James E Harvey  57 , Josep Rodés-Cabau  56 , Norbert Klein  51 , Sajjad A Sabir  31 , Jung-Sun Kim  29 , Stephane Cook  28 , Ran Kornowski  26 , Antti Saraste  18 , Jens E Nielsen-Kudsk  17 , Dhiraj Gupta  9 , Lucas Boersma  5 , Lorenz Räber  3 , Kolja Sievert  1 , Horst Sievert  68 , Stefan Bertog  1
Affiliations
Multicenter Study

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

Sophie Eppinger et al. Cardiovasc Revasc Med. 2024 Jul.

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.

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

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Conflict of interest statement

Declaration of competing interest A. Aminian is a consultant and proctor for Boston Scientific and Abbott. I. Akin received lecture and proctoring fees from Boston Scientific for the Watchman Okkluder. J. Lund discloses a clinical advisor (proctor) role in LAAC (Abbott) and lecture fees (Abbott, Boston scientific). E. Guerios serves as proctor for LAA closure for Abbott and Lifetech Scientific. N. Amabile has received proctoring and consulting fees from Abbott Vascular and Boston Scientific. C. Skurk has received proctor honoraria from Boston Scientific and speaker fees from Boston Scientific and Lifetech Scientific. J. Harvey is proctor for Abiomed, Boston Scientific and Medtronic and part of the Speaker's bureau for Abiomed, Boston Scientific and Medtronic. He also is part of the advisory board for Avail, Boston Scientific and Medtronic. H. Sievert has received study honoraria to institution, travel expenses and consulting fees from 4tech Cardio, Abbott, Ablative Solutions, Adona Medical, Akura Medical, Ancora Heart, Append Medical, Axon, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Cardiac Dimensions, Cardiac Success, Cardimed, Cardionovum, Celonova, Contego, Coramaze, Croivalve, CSL Behring LLC, CVRx, Dinova, Edwards, Endobar, Endologix, Endomatic, Esperion Therapeutics, Inc., Hangzhou Nuomao Medtech, Holistick Medical, Intershunt, Intervene, K2, Laminar, Lifetech, Magenta, Maquet Getinge Group, Metavention, Mitralix, Mokita, Neurotronic, NXT Biomedical, Occlutech, Recor, Renal Guard, Shifamed, Terumo, Trisol, Vascular Dynamics, Vectorious Medtech, Venus, Venock, Vivasure Medical, Vvital Biomed and Whiteswell. M. Kühne received personal fees from Bayer, Böhringer Ingelheim, Pfizer BMS, Daiichi Sankyo, Medtronic, Biotronik, Boston Scientific, Johnson & Johnson, and F. Hoffmann-La Roche Ltd., as well as grants from Bayer, Pfizer, Boston Scientific, BMS, Biotronik, and Daiichi Sankyo. S. Sabir is part of the Boston Scientific WATCHMAN advisory board. J. Kim has received proctoring fees from Abbott Vascular. M. Montorfano received consultant fees from Abbott, Boston Scientific, Kardia. M. Ancona received consultant fees from Abbott. Relevant research funding went to Vanderbilt University Medical Center from Boston Scientific, Boehringer-Ingelheim, Medtronic and Atricure, where C. Ellis is practicing. He also reseves a consultant and advisor fee from Abbott Medical, Atricure, Boston Scientific, Medtronic. L. Nombela-Franco is proctor for Abbott Vascular and has received lectures fees from Boston Scientific. A. Natale has received speaker honoraria from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik, and Medtronic. He also is a consultant for Biosense Webster, St. Jude Medical, and Janssen. All other authors declare that they have no competing interests.

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