Article
Author: Galea, Roberto ; Natale, Andrea ; Jung, Christian ; Pershad, Ashish ; Nielsen-Kudsk, Jens E ; Rosseel, Liesbeth ; Levi, Amos ; Sievert, Horst ; Armero, Sebastien ; Saraste, Antti ; Ding, Wern Y ; Alvarez, Xavier Millán ; Esteban, Pablo P ; Piayda, Kerstin ; Kim, Jung-Sun ; Räber, Lorenz ; Schell, Wendy ; Sandri, Marcus ; Lempereur, Mathieu ; Ellis, Christopher R ; Ancona, Marco B M ; Ebelt, Henning ; Afzal, Shazia ; Gupta, Dhiraj ; Langel, Martin ; Nombela-Franco, Luis ; Boccuzzi, Giacomo ; Santos, Lino ; Boersma, Lucas ; Kornowski, Ran ; Clapp, Brian ; Amat-Santos, Ignacio J ; Lund, Juha ; Davtyan, Karapet V ; Rivero-Ayerza, Máximo ; Korsholm, Kasper ; Shin, Seung Y ; Lee, Oh-Hyun ; Schuler, Brian T ; Marijon, Eloi ; Karabay, Can Y ; Güner, Ahmet ; Mesnier, Jules ; Galache Osuna, Jose G ; van der Pals, Jesper ; Montorfano, Matteo ; Giannini, Francesco ; Harvey, James E ; Moceri, Pamela ; Klein, Norbert ; Sievert, Kolja ; McKinney, Heather L ; Assa, Hana Vaknin ; Cruz-Gonzalez, Ignacio ; Amabile, Nicolas ; Sabir, Sajjad A ; Kühne, Michael ; Ghassan, Moubarak ; Aminian, Adel ; Merkulov, Evgeny ; Abelson, Mark ; Della Rocca, Domenico G ; Sabbag, Avi ; Mansourati, Jacques ; de Backer, Ole ; Eppinger, Sophie ; Mark, George ; Rodés-Cabau, Josep ; Spence, Mark ; Gaspardone, Achille ; Schmidt, Thomas Robert ; Osadchiy, Andrey ; Akin, Ibrahim ; Chugunov, Ivan A ; Ram, Pradhum ; Goyal, Sandeep K ; Cook, Stephane ; Lehmann, Sonja ; Guerios, Enio ; Gheorghe, Livia ; Maarse, Moniek ; Skurk, Carsten ; Kefer, Joelle ; Chen, Weita ; de Potter, Tom ; Ledwoch, Jakob ; Bertog, Stefan ; Nappi, Francesco ; Fernández-Armenta, Juan
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.