Percutaneous Retrieval of Dislodged Left Atrial Appendage Occlusion Devices through the Transseptal Approach

Abstract

Percutaneous left atrial appendage (LAA) occlusion is a promising treatment option in patients with atrial fibrillation who have a high risk of embolic stroke and are not eligible for chronic oral anticoagulation therapy. This procedure, however, can induce several complications. Device embolization can result in a serious situation, requiring immediate and safe device removal. We report two cases in which dislodged LAA occlusion devices were flitting in the left atrium or entrapped in the mitral valve leaflets and were successfully retrieved through a transseptal approach without complications.

Percutaneous retrieval of a dislocated LAmbre left atrial appendage occluder in a canine model

“…The reasons for device dislocation are not entirely clear yet. The following may all lead to device dislocation: improper device selection (device under‐sizing or aggressive oversizing), incorrect device apposition, a shallow landing zone, vigorous wiggle test, conversion from AF to sinus rhythm and active body movement before complete endothelialization of the device 5,11,12 …”

“…Retrieval of WATCHMAN can be technically more challenging than ACP 12 . The occluder located into the LV cavity is more challenging, followed by the LA and the AO 5,11 …”

“…Our findings are similar to previous studies. Previous studies have shown that embolization into the AO or the LA can be successfully managed by percutaneous techniques in most cases 5,11,15–17 . However, device embolization into the LV is associated with a higher rate of surgical retrieval.…”

“…This was somewhat different from previous reports of retrieval methods. Previous studies have reported the successful retrieval of dislocated occluders are successful with the help of snares 11,12,15–17 . In the present study, we used a disposable grasping rat‐tooth forceps.…”

The point of no return for percutaneous left atrial appendage closure: Towards to CHA2DS2‐VALAAc Score?

“…However, AF has been now accepted as a risk marker for stroke rather a risk factor for ischemic stroke . It is clear that there is an unmet need for stroke prevention in patients unable to take anticoagulation but it is also unclear if LAAc devices would be the right option in these patients because of its invasive nature . The postprocedural antithrombotic regimens were not uniform in most non‐RCTs and the DOAC data were limited.…”