Watchman Device Dislodgement Creating a Left Ventricular Outflow Tract Obstruction Requiring Emergency Cardiopulmonary Bypass

Abstract

Left atrial appendage (LAA) occlusion device implantation is becoming a more common alternative for stroke prophylaxis in patients with nonvalvular atrial fibrillation (AF) who are not able to tolerate long-term anticoagulation. Studies suggest the procedure has a 98.5% successful deployment rate (Boersma et al., 2016). We present a case where a rare but known complication involving dislodgement and migration of an implanted Watchman LAA occlusion device led to functional stenosis of the aortic valve creating a left ventricular outflow tract (LVOT) obstruction necessitating emergency cardiopulmonary bypass in the electrophysiology lab to safely retrieve the device.

Endovascular retrieval of left atrial appendage closure device embolized to the aorta

“… 7 , 8 In unstable patients who develop ventricular outflow obstruction from displacement of the device, median sternotomy and more invasive measures could be indicated. 9 However, only one other report in the literature has described using a catheter for retrieval of an LAAC device from the left ventricular outflow tract. 10 …”