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

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 retros...

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Published in:	Cardiovascular revascularization medicine Vol. 64; pp. 7 - 14
Main Authors:	Eppinger, Sophie, Piayda, Kerstin, Galea, Roberto, Sandri, Marcus, Maarse, Moniek, Güner, Ahmet, Karabay, Can Y., Pershad, Ashish, Ding, Wern Y., Aminian, Adel, Akin, Ibrahim, Davtyan, Karapet V., Chugunov, Ivan A., Marijon, Eloi, Rosseel, Liesbeth, Schmidt, Thomas Robert, Amabile, Nicolas, Korsholm, Kasper, Lund, Juha, Guerios, Enio, Amat-Santos, Ignacio J., Boccuzzi, Giacomo, Ellis, Christopher R., Sabbag, Avi, Ebelt, Henning, Clapp, Brian, Assa, Hana Vaknin, Levi, Amos, Ledwoch, Jakob, Lehmann, Sonja, Lee, Oh-Hyun, Mark, George, Schell, Wendy, della Rocca, Domenico G., Natale, Andrea, de Backer, Ole, Kefer, Joelle, Esteban, Pablo P., Abelson, Mark, Ram, Pradhum, Moceri, Pamela, Galache Osuna, Jose G., Alvarez, Xavier Millán, Cruz-Gonzalez, Ignacio, de Potter, Tom, Ghassan, Moubarak, Osadchiy, Andrey, Chen, Weita, Goyal, Sandeep K., Giannini, Francesco, Rivero-Ayerza, Máximo, Afzal, Shazia, Jung, Christian, Skurk, Carsten, Langel, Martin, Spence, Mark, Merkulov, Evgeny, Lempereur, Mathieu, Shin, Seung Y., Mesnier, Jules, McKinney, Heather L., Schuler, Brian T., Armero, Sebastien, Gheorghe, Livia, Ancona, Marco B.M., Santos, Lino, Mansourati, Jacques, Nombela-Franco, Luis, Nappi, Francesco, Kühne, Michael, Gaspardone, Achille, van der Pals, Jesper, Montorfano, Matteo, Fernández-Armenta, Juan, Harvey, James E., Rodés-Cabau, Josep, Klein, Norbert, Sabir, Sajjad A., Kim, Jung-Sun, Cook, Stephane, Kornowski, Ran, Saraste, Antti, Nielsen-Kudsk, Jens E., Gupta, Dhiraj, Boersma, Lucas, Räber, Lorenz, Sievert, Kolja, Sievert, Horst, Bertog, Stefan
Format:	Journal Article Web Resource
Language:	English
Published:	United States Elsevier Inc 01-07-2024
Subjects:	Aged Aged, 80 and over Atrial Appendage - diagnostic imaging Atrial Appendage - physiopathology Atrial fibrillation Atrial Fibrillation - mortality Atrial Fibrillation - therapy Cardiac and Cardiovascular Systems Cardiac Catheterization - adverse effects Cardiac Catheterization - instrumentation Cardiac Catheterization - mortality Cardiology and Cardiovascular Medicine Cardiovascular & respiratory systems Clinical Medicine Device embolization Device Removal - adverse effects Embolism - etiology Embolism - mortality Female Human health sciences Humans Kardiologi Klinisk medicin Left Atrial Appendage Closure Male Medical and Health Sciences Medicin och hälsovetenskap Middle Aged Occluder embolization Registries Retrieval strategy Retrospective Studies Risk Factors Sciences de la santé humaine Septal Occluder Device Stroke prevention Systèmes cardiovasculaire & respiratoire Time Factors Treatment Outcome Occluder embolization Device embolization AF Left atrial appendage closure Atrial fibrillation Retrieval strategy ICE LV LAA DOAC TIA BARC CT Stroke prevention LAAC SAPT TEE DAPT
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Summary:	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. Central Figure. Two patients died before any further intervention could be carried out which is the reason why they are not represented in this figure among the approaches. [Display omitted] •A percutaneous retrieval attempt was most often chosen as the primary rescue option.•Though the majority of embolization were detected within 24 hours, a considerable number of embolized occluders were detected later (29.6%).•76.8 % were asymptomatic upon emblization detection, the primary outcome occurred in 43.5 % and other major complications in 19.4 % of patients.•About one third of patients required a second rescue attempt, which was associated with higher mortality (first: 2.9% vs. second attempt: 21.4%).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 scopus-id:2-s2.0-85186995005
ISSN:	1553-8389 1878-0938 1878-0938
DOI:	10.1016/j.carrev.2024.02.014