A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes
Tekijät: 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
Kustantaja: Elsevier
Julkaisuvuosi: 2024
Journal: Cardiovascular revascularization medicine
Tietokannassa oleva lehden nimi: Cardiovascular Revascularization Medicine
Vuosikerta: 64
Aloitussivu: 7
Lopetussivu: 14
ISSN: 1553-8389
eISSN: 1878-0938
DOI: https://doi.org/10.1016/j.carrev.2024.02.014
Verkko-osoite: https://doi.org/10.1016/j.carrev.2024.02.014
Rinnakkaistallenteen osoite: 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.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
