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Eppinger S, Piayda K, Galea R, Sandri M, Maarse M, Güner A, Karabay CY, Pershad A, Ding WY, Aminian A, Akin I, Davtyan KV, Chugunov IA, Marijon E, Rosseel L, Schmidt TR, Amabile N, Korsholm K, Lund J, Guerios E, Amat-Santos IJ, Boccuzzi G, Ellis CR, Sabbag A, Ebelt H, Clapp B, Assa HV, Levi A, Ledwoch J, Lehmann S, Lee OH, Mark G, Schell W, Della Rocca DG, Natale A, de Backer O, Kefer J, Esteban PP, Abelson M, Ram P, Moceri P, Galache Osuna JG, Alvarez XM, Cruz-Gonzalez I, de Potter T, Ghassan M, Osadchiy A, Chen W, Goyal SK, Giannini F, Rivero-Ayerza M, Afzal S, Jung C, Skurk C, Langel M, Spence M, Merkulov E, Lempereur M, Shin SY, Mesnier J, McKinney HL, Schuler BT, Armero S, Gheorghe L, Ancona MBM, Santos L, Mansourati J, Nombela-Franco L, Nappi F, Kühne M, Gaspardone A, van der Pals J, Montorfano M, Fernández-Armenta J, Harvey JE, Rodés-Cabau J, Klein N, Sabir SA, Kim JS, Cook S, Kornowski R, Saraste A, Nielsen-Kudsk JE, Gupta D, Boersma L, Räber L, Sievert K, Sievert H, Bertog S. Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes. Cardiovasc Revasc Med 2024:S1553-8389(24)00067-8. [PMID: 38448258 DOI: 10.1016/j.carrev.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
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.
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Affiliation(s)
| | - Kerstin Piayda
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | - Roberto Galea
- Department of Cardiology, Universitätsspital Bern, Bern, Switzerland
| | | | - Moniek Maarse
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Hospital, Istanbul, Turkey
| | - Can Y Karabay
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
| | - Ashish Pershad
- Department of Cardiology, Banner Health, Phoenix, AZ, USA
| | - Wern Y Ding
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Adel Aminian
- Department of Cardiology, Centre hospitalier universitaire de Charleroi, Charleroi, Belgium
| | - Ibrahim Akin
- Department of Cardiology, Universitätsmedizin Mannheim, Germany
| | - Karapet V Davtyan
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Ivan A Chugunov
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Eloi Marijon
- Department of Cardiology, Hôpital Européen Georges-Pompidou HEGP, Paris, France
| | | | | | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Juha Lund
- Heart Center, Turku University Hospital, Turku, Finland
| | - Enio Guerios
- Department of Cardiology, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | - Giacomo Boccuzzi
- Department of Cardiology, Ospedale san Giovanni Bosco, Torino, Italy
| | | | - Avi Sabbag
- Department of Cardiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Henning Ebelt
- Department of Cardiology, Katholisches Krankenhaus St. Nepomuk, Erfurt, Germany
| | - Brian Clapp
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | | | - Sonja Lehmann
- Department of Cardiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Oh-Hyun Lee
- Department of Cardiology, Yonsei University Hospital, Yongin, Republic of Korea
| | - George Mark
- The Heart House/Cooper University Camden, NJ, USA
| | - Wendy Schell
- Department of Cardiology, Cooper University Hospital, NJ, USA
| | | | - Andrea Natale
- Department of Cardiology, St David's Medical Center, Austin, TX, USA
| | - Ole de Backer
- Department of Cardiology, Rigshospitalet Copenhagen, Copenhagen, Denmark
| | - Joelle Kefer
- Department of Cardiology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Pablo P Esteban
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
| | - Mark Abelson
- Department of interventional Cardiology, Mediclinic Vergelegen, Cape Town, South Africa
| | - Pradhum Ram
- Department of Cardiology, Emory University, Atlanta, GA, USA
| | - Pamela Moceri
- Department of Cardiology, Hopital Pasteur 1, Nice, France
| | | | | | | | | | - Moubarak Ghassan
- Department of Cardiology, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Andrey Osadchiy
- Department of Cardiology, City Hospital #40, St. Petersburg, Russia
| | - Weita Chen
- Department of Cardiology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| | | | | | | | - Shazia Afzal
- Department of Cardiology, Heinrich-Heine University, University Hospital, Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Heinrich-Heine University, University Hospital, Duesseldorf, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Langel
- Department of Cardiology, Klinikum St. Georg, Leipzig, Germany
| | - Mark Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Trust, Belfast, UK
| | | | | | - Seung Y Shin
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Brian T Schuler
- Department of Cardiology, WellSpan York Hospital, York, PA, USA
| | | | - Livia Gheorghe
- Department of Cardiology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Marco B M Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lino Santos
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | | | | | | | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Switzerland
| | | | - Jesper van der Pals
- Department of Cardiology, Lund University and Skane University Hospital, Lund, Sweden
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - James E Harvey
- Department of Cardiology, WellSpan York Hospital, York, PA, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Norbert Klein
- Department of Cardiology, Klinikum St. Georg, Leipzig, Germany
| | - Sajjad A Sabir
- Department of Cardiology, Cooper University Hospital, NJ, USA
| | - Jung-Sun Kim
- Department of Cardiology, Yonsei University Hospital, Yongin, Republic of Korea
| | - Stephane Cook
- Department of Cardiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland
| | | | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Lorenz Räber
- Department of Cardiology, Universitätsspital Bern, Bern, Switzerland
| | - Kolja Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany.
| | - Stefan Bertog
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
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