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 Y. Karabay; Ashish Pershad; Wern Y. Ding; Adel Aminian; Ibrahim Akin; Karapet V. Davtyan; Ivan A. Chugunov; Eloi Marijon; Liesbeth Rosseel; Thomas Robert Schmidt; Nicolas Amabile; Kasper Korsholm; Juha Lund; Enio Guerios; Ignacio J. Amat-Santos; Giacomo Boccuzzi; Christopher R. Ellis; Avi Sabbag; Henning Ebelt; Brian Clapp; Hana Vaknin Assa; Amos Levi; Jakob Ledwoch; Sonja Lehmann; Oh-Hyun Lee; George Mark; Wendy Schell; Domenico G. della Rocca; Andrea Natale; Ole de Backer; Joelle Kefer; Pablo P. Esteban; Mark Abelson; Pradhum Ram; Pamela Moceri; Jose G. Galache Osuna; Xavier Millán Alvarez; Ignacio Cruz-Gonzalez; Tom de Potter; Moubarak Ghassan; Andrey Osadchiy; Weita Chen; Sandeep K. Goyal; Francesco Giannini; M. ximo Rivero-Ayerza; Shazia Afzal; Christian Jung; Carsten Skurk; Martin Langel; Mark Spence; Evgeny Merkulov; Mathieu Lempereur; Seung Y. Shin; Jules Mesnier; Heather L. McKinney; Brian T. 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 E. Harvey; Josep Rodés-Cabau; Norbert Klein; Sajjad A. Sabir; Jung-Sun Kim; Stephane Cook; Ran Kornowski; Antti Saraste; Jens E. Nielsen-Kudsk; Dhiraj Gupta; Lucas Boersma; Lorenz Räber; Kolja Sievert; Horst Sievert; Stefan Bertog

doi:10.1016/j.carrev.2024.02.014

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 Y. Karabay, Ashish Pershad, Wern Y. Ding, Adel Aminian, Ibrahim Akin, Karapet V. Davtyan, Ivan A. Chugunov, Eloi Marijon, Liesbeth Rosseel, Thomas Robert Schmidt, Nicolas Amabile, Kasper Korsholm, Juha Lund, Enio GueriosIgnacio J. Amat-Santos, Giacomo Boccuzzi, Christopher R. Ellis, Avi Sabbag, Henning Ebelt, Brian Clapp, Hana Vaknin Assa, Amos Levi, Jakob Ledwoch, Sonja Lehmann, Oh-Hyun Lee, George Mark, Wendy Schell, Domenico G. della Rocca, Andrea Natale, Ole de Backer, Joelle Kefer, Pablo P. Esteban, Mark Abelson, Pradhum Ram, Pamela Moceri, Jose G. Galache Osuna, Xavier Millán Alvarez, Ignacio Cruz-Gonzalez, Tom de Potter, Moubarak Ghassan, Andrey Osadchiy, Weita Chen, Sandeep K. Goyal, Francesco Giannini, M. ximo Rivero-Ayerza, Shazia Afzal, Christian Jung, Carsten Skurk, Martin Langel, Mark Spence, Evgeny Merkulov, Mathieu Lempereur, Seung Y. Shin, Jules Mesnier, Heather L. McKinney, Brian T. 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 E. Harvey, Josep Rodés-Cabau, Norbert Klein, Sajjad A. Sabir, Jung-Sun Kim, Stephane Cook, Ran Kornowski, Antti Saraste, Jens E. Nielsen-Kudsk, Dhiraj Gupta, Lucas Boersma, Lorenz Räber, Kolja Sievert, Horst Sievert, Stefan Bertog

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Journal	Cardiovascular Revascularization Medicine
Early online date	2024
DOIs	https://doi.org/10.1016/j.carrev.2024.02.014
Publication status	E-pub ahead of print - 2024

Keywords

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

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10.1016/j.carrev.2024.02.014

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Eppinger, S., Piayda, K., Galea, R., Sandri, M., Maarse, M., Güner, A., Karabay, C. Y., Pershad, A., Ding, W. Y., Aminian, A., Akin, I., Davtyan, K. V., Chugunov, I. A., Marijon, E., Rosseel, L., Schmidt, T. R., Amabile, N., Korsholm, K., Lund, J., ... Bertog, S. (2024). Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes. Cardiovascular Revascularization Medicine. Advance online publication. https://doi.org/10.1016/j.carrev.2024.02.014

@article{225450db2feb4154858511f314dbace3,

title = "Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes",

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",

author = "Sophie Eppinger and Kerstin Piayda and Roberto Galea and Marcus Sandri and Moniek Maarse and Ahmet G{\"u}ner and Karabay, {Can Y.} and Ashish Pershad and Ding, {Wern Y.} and Adel Aminian and Ibrahim Akin and Davtyan, {Karapet V.} and Chugunov, {Ivan A.} and Eloi Marijon and Liesbeth Rosseel and Schmidt, {Thomas Robert} and Nicolas Amabile and Kasper Korsholm and Juha Lund and Enio Guerios and Amat-Santos, {Ignacio J.} and Giacomo Boccuzzi and Ellis, {Christopher R.} and Avi Sabbag and Henning Ebelt and Brian Clapp and Assa, {Hana Vaknin} and Amos Levi and Jakob Ledwoch and Sonja Lehmann and Oh-Hyun Lee and George Mark and Wendy Schell and {della Rocca}, {Domenico G.} and Andrea Natale and {de Backer}, Ole and Joelle Kefer and Esteban, {Pablo P.} and Mark Abelson and Pradhum Ram and Pamela Moceri and {Galache Osuna}, {Jose G.} and Alvarez, {Xavier Mill{\'a}n} and Ignacio Cruz-Gonzalez and {de Potter}, Tom and Moubarak Ghassan and Andrey Osadchiy and Weita Chen and Goyal, {Sandeep K.} and Francesco Giannini and Rivero-Ayerza, {M. ximo} and Shazia Afzal and Christian Jung and Carsten Skurk and Martin Langel and Mark Spence and Evgeny Merkulov and Mathieu Lempereur and Shin, {Seung Y.} and Jules Mesnier and McKinney, {Heather L.} and Schuler, {Brian T.} and Sebastien Armero and Livia Gheorghe and Ancona, {Marco B. M.} and Lino Santos and Jacques Mansourati and Luis Nombela-Franco and Francesco Nappi and Michael K{\"u}hne and Achille Gaspardone and {van der Pals}, Jesper and Matteo Montorfano and Juan Fern{\'a}ndez-Armenta and Harvey, {James E.} and Josep Rod{\'e}s-Cabau and Norbert Klein and Sabir, {Sajjad A.} and Jung-Sun Kim and Stephane Cook and Ran Kornowski and Antti Saraste and Nielsen-Kudsk, {Jens E.} and Dhiraj Gupta and Lucas Boersma and Lorenz R{\"a}ber and Kolja Sievert and Horst Sievert and Stefan Bertog",

note = "Publisher Copyright: {\textcopyright} 2024",

year = "2024",

doi = "10.1016/j.carrev.2024.02.014",

language = "English",

journal = "Cardiovascular Revascularization Medicine",

issn = "1553-8389",

publisher = "Elsevier Inc.",

}

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, O-H, 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, MX, 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, J-S, Cook, S, Kornowski, R, Saraste, A, Nielsen-Kudsk, JE, Gupta, D, Boersma, L, Räber, L, Sievert, K, Sievert, H & Bertog, S 2024, 'Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes', Cardiovascular Revascularization Medicine. https://doi.org/10.1016/j.carrev.2024.02.014

TY - JOUR

T1 - Embolization of percutaneous left atrial appendage closure devices

T2 - timing, management and clinical outcomes

AU - Eppinger, Sophie

AU - Piayda, Kerstin

AU - Galea, Roberto

AU - Sandri, Marcus

AU - Maarse, Moniek

AU - Güner, Ahmet

AU - Karabay, Can Y.

AU - Pershad, Ashish

AU - Ding, Wern Y.

AU - Aminian, Adel

AU - Akin, Ibrahim

AU - Davtyan, Karapet V.

AU - Chugunov, Ivan A.

AU - Marijon, Eloi

AU - Rosseel, Liesbeth

AU - Schmidt, Thomas Robert

AU - Amabile, Nicolas

AU - Korsholm, Kasper

AU - Lund, Juha

AU - Guerios, Enio

AU - Amat-Santos, Ignacio J.

AU - Boccuzzi, Giacomo

AU - Ellis, Christopher R.

AU - Sabbag, Avi

AU - Ebelt, Henning

AU - Clapp, Brian

AU - Assa, Hana Vaknin

AU - Levi, Amos

AU - Ledwoch, Jakob

AU - Lehmann, Sonja

AU - Lee, Oh-Hyun

AU - Mark, George

AU - Schell, Wendy

AU - della Rocca, Domenico G.

AU - Natale, Andrea

AU - de Backer, Ole

AU - Kefer, Joelle

AU - Esteban, Pablo P.

AU - Abelson, Mark

AU - Ram, Pradhum

AU - Moceri, Pamela

AU - Galache Osuna, Jose G.

AU - Alvarez, Xavier Millán

AU - Cruz-Gonzalez, Ignacio

AU - de Potter, Tom

AU - Ghassan, Moubarak

AU - Osadchiy, Andrey

AU - Chen, Weita

AU - Goyal, Sandeep K.

AU - Giannini, Francesco

AU - Rivero-Ayerza, M. ximo

AU - Afzal, Shazia

AU - Jung, Christian

AU - Skurk, Carsten

AU - Langel, Martin

AU - Spence, Mark

AU - Merkulov, Evgeny

AU - Lempereur, Mathieu

AU - Shin, Seung Y.

AU - Mesnier, Jules

AU - McKinney, Heather L.

AU - Schuler, Brian T.

AU - Armero, Sebastien

AU - Gheorghe, Livia

AU - Ancona, Marco B. M.

AU - Santos, Lino

AU - Mansourati, Jacques

AU - Nombela-Franco, Luis

AU - Nappi, Francesco

AU - Kühne, Michael

AU - Gaspardone, Achille

AU - van der Pals, Jesper

AU - Montorfano, Matteo

AU - Fernández-Armenta, Juan

AU - Harvey, James E.

AU - Rodés-Cabau, Josep

AU - Klein, Norbert

AU - Sabir, Sajjad A.

AU - Kim, Jung-Sun

AU - Cook, Stephane

AU - Kornowski, Ran

AU - Saraste, Antti

AU - Nielsen-Kudsk, Jens E.

AU - Gupta, Dhiraj

AU - Boersma, Lucas

AU - Räber, Lorenz

AU - Sievert, Kolja

AU - Sievert, Horst

AU - Bertog, Stefan

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

KW - Atrial fibrillation

KW - Device embolization

KW - Left atrial appendage closure

KW - Occluder embolization

KW - Retrieval strategy

KW - Stroke prevention

UR - http://www.scopus.com/inward/record.url?scp=85186995005&partnerID=8YFLogxK

U2 - 10.1016/j.carrev.2024.02.014

DO - 10.1016/j.carrev.2024.02.014

M3 - Article

C2 - 38448258

SN - 1553-8389

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

ER -

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

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