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

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

doi:10.1016/j.carrev.2024.02.014

Journal Articles Cardiovascular Revascularization Medicine Year : 2024

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

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Sophie Eppinger

Function : Author

Kerstin Piayda

Function : Author

Roberto Galea

Function : Author

Marcus Sandri

Function : Author

University Hospital Leipzig = Universitätsklinikum Leipzig

Moniek Maarse

Function : Author

Ahmet Güner

Function : Author

Can Karabay

Function : Author

Ashish Pershad

Function : Author

Wern Ding

Function : Author

Adel Aminian

Function : Author

Service of Cardiology - CHU Charleroi

Ibrahim Akin

Function : Author

University of Heidelberg, Medical Faculty

Karapet Davtyan

Function : Author

Ivan Chugunov

Function : Author

Eloi Marijon

Function : Author

Hôpital Européen Georges Pompidou [APHP]

Liesbeth Rosseel

Function : Author

Thomas Robert Schmidt

Function : Author

Nicolas Amabile

Function : Author

Institut Mutualiste de Montsouris

Kasper Korsholm

Function : Author

Juha Lund

Function : Author

Enio Guerios

Function : Author

Ignacio Amat-Santos

Function : Author

Giacomo Boccuzzi

Function : Author

Christopher Ellis

Function : Author

Avi Sabbag

Function : Author

Henning Ebelt

Function : Author

Brian Clapp

Function : Author

Hana Vaknin Assa

Function : Author

Amos Levi

Function : Author

Jakob Ledwoch

Function : Author

Sonja Lehmann

Function : Author

Oh-Hyun Lee

Function : Author

George Mark

Function : Author

Wendy Schell

Function : Author

Domenico Della Rocca

Function : Author

Andrea Natale

Function : Author

Ole de Backer

Function : Author

Joelle Kefer

Function : Author

Pablo Esteban

Function : Author

Mark Abelson

Function : Author

Pradhum Ram

Function : Author

Pamela Moceri

Function : Author

Jose Galache Osuna

Function : Author

Xavier Millán Alvarez

Function : Author

Ignacio Cruz-Gonzalez

Function : Author

Tom de Potter

Function : Author

Moubarak Ghassan

Function : Author

Andrey Osadchiy

Function : Author

Weita Chen

Function : Author

Sandeep Goyal

Function : Author

Francesco Giannini

Function : Author

Máximo Rivero-Ayerza

Function : Author

Shazia Afzal

Function : Author

Christian Jung

Function : Author

Carsten Skurk

Function : Author

Martin Langel

Function : Author

Mark Spence

Function : Author

Evgeny Merkulov

Function : Author

Mathieu Lempereur

Function : Author

Seung Shin

Function : Author

Jules Mesnier

Function : Author

Heather Mckinney

Function : Author

Brian Schuler

Function : Author

Sebastien Armero

Function : Author

Livia Gheorghe

Function : Author

Marco B.M. Ancona

Function : Author

Lino Santos

Function : Author

Jacques Mansourati

Function : Author

Hôpital de la Cavale Blanche - CHRU Brest

Optimisation des régulations physiologiques

Luis Nombela-Franco

Function : Author

Francesco Nappi

Function : Author

Michael Kühne

Function : Author

Achille Gaspardone

Function : Author

Jesper van der Pals

Function : Author

Matteo Montorfano

Function : Author

Juan Fernández-Armenta

Function : Author

James Harvey

Function : Author

Josep Rodés-Cabau

Function : Author

Norbert Klein

Function : Author

Sajjad Sabir

Function : Author

Jung-Sun Kim

Function : Author

Stephane Cook

Function : Author

Ran Kornowski

Function : Author

Antti Saraste

Function : Author

Jens Nielsen-Kudsk

Function : Author

Dhiraj Gupta

Function : Author

Lucas Boersma

Function : Author

Lorenz Räber

Function : Author

Kolja Sievert

Function : Author

Horst Sievert

Function : Author

Stefan Bertog

Function : Author

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.

Keywords

Atrial fibrillation Device embolization Left atrial appendage closure Occluder embolization Retrieval strategy Stroke prevention

Domains

Life Sciences [q-bio]

Catherine Bertignac : Connect in order to contact the contributor

https://hal.univ-brest.fr/hal-04905258

Submitted on : Wednesday, January 22, 2025-9:21:17 AM

Last modification on : Thursday, January 23, 2025-3:22:15 AM

Dates and versions

hal-04905258 , version 1 (22-01-2025)

Identifiers

HAL Id : hal-04905258 , version 1
DOI : 10.1016/j.carrev.2024.02.014

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Sophie Eppinger, Kerstin Piayda, Roberto Galea, Marcus Sandri, Moniek Maarse, et al.. Embolization of percutaneous left atrial appendage closure devices: Timing, management and clinical outcomes. Cardiovascular Revascularization Medicine, 2024, 64, pp.7-14. ⟨10.1016/j.carrev.2024.02.014⟩. ⟨hal-04905258⟩

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

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