Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes
(2024) In Cardiovascular Revascularization Medicine- 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... (More)
- 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. © 2024 (Less)
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- author
- Eppinger, S. ; van der Pals, J. LU and Bertog, S.
- author collaboration
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- Atrial fibrillation, Device embolization, Left atrial appendage closure, Occluder embolization, Retrieval strategy, Stroke prevention
- in
- Cardiovascular Revascularization Medicine
- publisher
- Elsevier
- external identifiers
-
- scopus:85186995005
- pmid:38448258
- ISSN
- 1553-8389
- DOI
- 10.1016/j.carrev.2024.02.014
- language
- English
- LU publication?
- yes
- additional info
- Number of authors = 89 EID = 85186995005 Affiliation = Eppinger S., CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany Affiliation = Sievert H., CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany Affiliation = Bertog S., CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
- id
- 2bf2148d-4481-4d7b-89c5-ca829d4f39ce
- date added to LUP
- 2024-04-03 15:24:36
- date last changed
- 2024-04-04 03:00:08
@article{2bf2148d-4481-4d7b-89c5-ca829d4f39ce,
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. © 2024}},
author = {{Eppinger, S. and van der Pals, J. and Bertog, S.}},
issn = {{1553-8389}},
keywords = {{Atrial fibrillation; Device embolization; Left atrial appendage closure; Occluder embolization; Retrieval strategy; Stroke prevention}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Cardiovascular Revascularization Medicine}},
title = {{Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes}},
url = {{http://dx.doi.org/10.1016/j.carrev.2024.02.014}},
doi = {{10.1016/j.carrev.2024.02.014}},
year = {{2024}},
}