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.
Embolization of percutaneous left atrial appendage closure devices: Timing, management and clinical outcomes / Eppinger, S.; Piayda, K.; Galea, R.; Sandri, M.; Maarse, M.; Guner, A.; Karabay, C. Y.; Pershad, A.; Ding, W. Y.; Aminian, A.; Akin, I.; Davtyan, K. V.; Chugunov, I. A.; Marijon, E.; Rosseel, L.; Schmidt, T. R.; Amabile, N.; Korsholm, K.; Lund, J.; Guerios, E.; Amat-Santos, I. J.; Boccuzzi, G.; Ellis, C. R.; Sabbag, A.; Ebelt, H.; Clapp, B.; Assa, H. V.; Levi, A.; Ledwoch, J.; Lehmann, S.; Lee, O. -H.; Mark, G.; Schell, W.; della Rocca, D. G.; Natale, A.; de Backer, O.; Kefer, J.; Esteban, P. P.; Abelson, M.; Ram, P.; Moceri, P.; Galache Osuna, J. G.; Alvarez, X. M.; Cruz-Gonzalez, I.; de Potter, T.; Ghassan, M.; Osadchiy, A.; Chen, W.; Goyal, S. K.; Giannini, F.; Rivero-Ayerza, M.; Afzal, S.; Jung, C.; Skurk, C.; Langel, M.; Spence, M.; Merkulov, E.; Lempereur, M.; Shin, S. Y.; Mesnier, J.; Mckinney, H. L.; Schuler, B. T.; Armero, S.; Gheorghe, L.; Ancona, M. B. M.; Santos, L.; Mansourati, J.; Nombela-Franco, L.; Nappi, F.; Kuhne, M.; Gaspardone, A.; van der Pals, J.; Montorfano, M.; Fernandez-Armenta, J.; Harvey, J. E.; Rodes-Cabau, J.; Klein, N.; Sabir, S. A.; Kim, J. -S.; Cook, S.; Kornowski, R.; Saraste, A.; Nielsen-Kudsk, J. E.; Gupta, D.; Boersma, L.; Raber, L.; Sievert, K.; Sievert, H.; Bertog, S.. - In: CARDIOVASCULAR REVASCULARIZATION MEDICINE. - ISSN 1553-8389. - 64:(2024), pp. 7-14. [10.1016/j.carrev.2024.02.014]
Embolization of percutaneous left atrial appendage closure devices: Timing, management and clinical outcomes
Montorfano M.;
2024-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
