Author + information
- Mohit K. Turagam, MDa,
- Petr Neuzil, MD, PhDb,
- Srinivas R. Dukkipati, MDa,
- Jan Petru, MDb,
- Ivo Skalsky, MDb,
- Menachem M. Weiner, MDc and
- Vivek Y. Reddy, MDa,∗ ()
- aCardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York
- bDepartment of Cardiology, Na Homolce Hospital, Prague, Czech Republic
- cDepartment of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Vivek Y. Reddy, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Objectives This study sought to evaluate the safety and feasibility of percutaneous retrieval of left atrial appendage closure (LAAC) devices with an endoscopic grasping tool.
Background Transcatheter LAAC is a mechanical stroke prevention strategy in patients with nonvalvular atrial fibrillation (AF) who are poor candidates for long-term oral anticoagulation. However, these LAAC devices can be inadvertently released into an unfavorable location, the device might migrate to a different (unfavorable) position within the left atrial appendage (LAA) or may embolize from the heart into the aorta. In such instances, it can be challenging to remove the LAAC device without open cardiac or vascular surgery.
Methods This study reports on a series of 4 cases in which an endoscopic grasping tool (Raptor) designed for gastrointestinal applications was used to percutaneously (non-surgically) remove LAAC devices that were either malpositioned or embolized.
Results LAAC devices were safely and non-surgically removed using the grasping device in all 4 cases (Amulet: 1, Watchman: 3). Devices were successfully retrieved from the left inferior pulmonary vein, descending aorta, aortic arch, and the edge of the LAA ostium. Time of device retrieval post-LAAC implantation ranged from 24 h to 1 year. Special precautionary measures, such as preemptive pericardial access, embolic protection devices, and intraprocedural imaging, were used in 2 cases.
Conclusions This case series demonstrated that the endoscopic grasping tool appeared to be safe and useful to percutaneously retrieve LAAC devices.
Dr. Dukkipati has received a research grant from Biosense-Webster; and has been a member of the Advisory Board for Abiomed. Dr. Reddy has received a research grant and has been a consultant for Abbott and Boston Scientific; an extended list of his relationships with industry appears in the Online Appendix. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 9, 2019.
- Revision received November 14, 2019.
- Accepted November 21, 2019.
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