A1 Refereed original research article in a scientific journal
Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes
Authors: Eppinger, Sophie; Piayda, Kerstin; Galea, Roberto; Sandri, Marcus; Maarse, Moniek; Güner, Ahmet; Karabay, Can Y.; Pershad, Ashish; Ding, Wern Y.; Aminian, Adel; Akin, Ibrahim; Davtyan, Karapet V.; Chugunov, Ivan A.; Marijon, Eloi; Rosseel, Liesbeth; Schmidt, Thomas Robert; Amabile, Nicolas; Korsholm, Kasper; Lund, Juha; Guerios, Enio; Amat-Santos, Ignacio J.; Boccuzzi, Giacomo; Ellis, Christopher R.; Sabbag, Avi; Ebelt, Henning; Clapp, Brian; Assa, Hana Vaknin; Levi, Amos; Ledwoch, Jakob; Lehmann, Sonja; Lee, Oh-Hyun; Mark, George; Schell, Wendy; dellaRocca, Domenico G.; Natale, Andrea; de Backer, Ole; Kefer, Joelle; Esteban, Pablo P.; Abelson, Mark; Ram, Pradhum; Moceri, Pamela; Galache Osuna, Jose G.; Alvarez, Xavier Millán; Cruz-Gonzalez, Ignacio; de Potter, Tom; Ghassan, Moubarak; Osadchiy, Andrey; Chen, Weita; Goyal, Sandeep K.; Giannini, Francesco; Rivero-Ayerza, Máximo; Afzal, Shazia; Jung, Christian; Skurk, Carsten; Langel, Martin; Spence, Mark; Merkulov, Evgeny; Lempereur, Mathieu; Shin, Seung Y.; Mesnier, Jules; McKinney, Heather L.; Schuler, Brian T.; Armero, Sebastien; Gheorghe, Livia; Ancona, Marco B. M.; Santos, Lino; Mansourati, Jacques; Nombela-Franco, Luis; Nappi, Francesco; Kühne, Michael; Gaspardone, Achille; van der Pals, Jesper; Montorfano, Matteo; Fernández-Armenta, Juan; Harvey, James E.; Rodés-Cabau, Josep; Klein, Norbert; Sabir, Sajjad A.; Kim, Jung-Sun; Cook, Stephane; Kornowski, Ran; Saraste, Antti; Nielsen-Kudsk, Jens E.; Gupta, Dhiraj; Boersma, Lucas; Räber, Lorenz; Sievert, Kolja; Sievert, Horst; Bertog, Stefan
Publisher: Elsevier
Publication year: 2024
Journal: Cardiovascular revascularization medicine
Journal name in source: Cardiovascular Revascularization Medicine
Volume: 64
First page : 7
Last page: 14
ISSN: 1553-8389
eISSN: 1878-0938
DOI: https://doi.org/10.1016/j.carrev.2024.02.014
Publication's open availability at the time of reporting: No Open Access
Publication channel's open availability : Partially Open Access publication channel
Web address : https://doi.org/10.1016/j.carrev.2024.02.014
Self-archived copy’s web address: https://orbi.uliege.be/bitstream/2268/319800/1/LAAO%20Embolization-Registry.pdf
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.
Funding information in the publication:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
