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Percutaneous Retrieval of a Left Atrial Appendage Closure Device: The Device Waltz.

ABSTRACT: Embolization of a device in patients undergoing percutaneous left atrial appendage closure is an uncommon complication. We present an illustrative case of successful percutaneous retrieval of an embolized LAmbre device (Lifetech Scientiﬁc, Shenzhen, China) that was achieved with a combination of a snaring technique and forceps grasping and by using a steerable guiding catheter. (Level of Difficulty: Advanced.).

SUBMITTER: Gaspardone A

PROVIDER: S-EPMC8311156 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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Percutaneous Retrieval of a Left Atrial Appendage Closure Device: The Device Waltz.

Gaspardone Achille A Giannico Maria Benedetta MB Cancellieri Roberto R Velardi Laura L Posteraro Antonio Giuseppe AG Cinque Alessandra A Iamele Maria M

JACC. Case reports 20210401 5

Embolization of a device in patients undergoing percutaneous left atrial appendage closure is an uncommon complication. We present an illustrative case of successful percutaneous retrieval of an embolized LAmbre device (Lifetech Scientiﬁc, Shenzhen, China) that was achieved with a combination of a snaring technique and forceps grasping and by using a steerable guiding catheter. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 34317622

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Percutaneous retrieval via transseptal access of an Amplatzer Amulet left atrial appendage closure device embolized in the left ventricle.

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Percutaneous left atrial appendage closure using the LAmbre device in patients with atrial fibrillation and left atrial appendage thrombus

Project description:Background Left atrial appendage closure (LAAC) is considered a valid alternative for the prevention of thromboembolic stroke in patients with persistent left atrial appendage thrombus (LAAT) despite adequate anticoagulation. However, the data on LAAC using the LAmbre device for patients with LAAT is limited. This study was performed to explore efficacy and safety as well as to share the experience of the modified LAAC procedure with the LAmbre device. Materials and methods A total of 7 patients with persistent LAAT despite adequate anticoagulation underwent modified LAAC with the LAmbre device between November 2019 and April 2022. Transesophageal echocardiography was performed 3 months postoperatively to detect device-related thrombosis and peridevice leak. The patients’ clinical events were evaluated during the perioperative and follow-up periods. Results The median age, CHA2DS2-VASc score, and HAS-BLED score of all patients were 71 [53–73], 3 [2–4], and 2 [2–3], respectively. In the procedure, a cerebral protection system was used in two patients. LAAC with the LAmbre device was successfully performed in all patients without perioperative events. During the median follow-up of 383 [325–865] days, postoperative transesophageal echocardiography was performed in six (85.7%) patients. Device-related thrombosis was detected in one (16.7%) patient, and no significant peridevice leak was observed. No thromboembolic event or bleeding event occurred in any patients. Conclusion LAAC with the LAmbre device is effective and safe when performed by experienced operators in highly selected patients with LAAT after adequate anticoagulation.

| S-EPMC9729287 | biostudies-literature

Percutaneous retrieval of an embolized left atrial appendage closure device from the left atrium in a patient with previous MitraClips.

Project description:BackgroundLeft atrial appendage closure is increasingly used. LAA closure procedures can rarely be complicated by device embolization, typically towards the aorta. In this case report, we describe the successful percutaneous retrieval of an embolized Amulet device from the left atrium in a patient with previous MitraClips.Case presentationBy guidance of intracardiac echocardiography (ICE) and under local anaesthesia, two guiding systems were introduced into the LA; one to stabilize the device against the lateral LA wall and one large system to retrieve the device. However, the LAA closure device was finally snared by a three-loop snare and pulled across the interatrial septum (IAS) without taking the device into a protective guiding sheath - and this without tearing the IAS.ConclusionsIn conclusion, percutaneous retrieval of an embolized LAA closure device from the LA is feasible by transseptal approach under local anaesthesia and with ICE guidance.

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Percutaneous left atrial appendage closure in a surgically ligated left atrial appendage.

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Retrieval of embolised left atrial appendage closure devices.

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Percutaneous Retrieval of Left Atrial Appendage Closure Devices in Patients With Atrial Fibrillation: A Case Report.

Project description:Left atrial appendage closure (LAAC) devices can be inadvertently released into unfavorable locations, which may allow them to migrate to a different position within the left atrial appendage or embolize from the heart into the aorta. In such instances, it can be challenging to remove the LAAC device. Here, we present two cases in which patients with atrial fibrillation experienced LAAC device exposure at an inappropriate site because of interventional operator error and device mismatch: (a) the LAAC device was dislodged into the aortic arch and retrieved percutaneously from the femoral artery route, and (b) in the left atrium, which was dislodged into the left atrium and retrieved via atrial transseptal puncture of the femoral vein.

| S-EPMC9301371 | biostudies-literature

Left atrial appendage perforation during appendage angiography treated by percutaneous left atrial appendage closure: a case report.

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| S-EPMC8183657 | biostudies-literature

Percutaneous left atrial appendage closure with superior vascular access.

Project description: Not available

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Frailty in patients undergoing percutaneous left atrial appendage closure.

Project description:BackgroundFrailty is associated with significant morbidity and mortality in older adults. Whether frailty predicts adverse outcomes after percutaneous left atrial appendage closure (LAAC) remains uncertain.ObjectiveThe purpose of this study was to examine the association between frailty and clinical outcomes after percutaneous LAAC.MethodsWe identified patients 65 years and older in Medicare fee-for-service claims who underwent LAAC between October 1, 2016, and December 31, 2019. Patients were identified as frail on the basis of the Hospital Frailty Risk Score (HFRS), a validated frailty measure centered on health resource utilization, with the cohort stratified into low (<5), intermediate (5-15), and high (>15) risk groups.ResultsOf the 21,787 patients who underwent LAAC, 10,740 (49.3%) were considered frail (HFRS >5), including 3441 (15.8%) in the high-risk group. The mortality rate (up to 1095 days) were 16.1% in the low-risk group, 26.7% in the intermediate-risk group, and 41.1% in the high-risk group (P < .001). After adjusting for age, sex, and comorbidities, HFRS >15 (compared with HFRS <5) was associated with a higher risk of long hospital stay (odds ratio [OR] 8.29; 95% confidence interval [CI] 5.94-11.57), 30-day readmission (OR 1.80, 95% CI 1.58-2.05), 30-day mortality (OR 5.68, 95% CI 3.40-9.40), and 1-year mortality (OR 2.83, 95% CI 2.39-3.35). In restricted cubic spline models, the adjusted OR for all outcomes monotonically increased with increasing HFRS.ConclusionFrailty is common in patients undergoing LAAC and is associated with increased risks of long hospital stay, readmissions, and short-term mortality.

| S-EPMC9968991 | biostudies-literature

Percutaneous left atrial appendage closure: beyond the classic indications.

Project description:Percutaneous left atrial appendage closure (LAAC) has proven to be an effective alternative to oral anticoagulation (OAC) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). International guidelines traditionally recommend LAAC for NVAF patients at high thromboembolic risk and contraindication to or at high risk for OAC. However, there are many other clinical situations in which this procedure may also be beneficial. This paper discusses the potential role of LAAC in specific haemorrhagic diseases (cerebral amyloid angiopathy, age-related macular degeneration, hereditary haemorrhagic telangiectasia, and Moyamoya disease), after left atrial appendage (LAA) electrical isolation, in cases of persistent thrombus inside the LAA, in end-stage renal disease and in special groups of patients for whom low compliance and persistence to OAC may be anticipated.

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