Retrograde transaortic percutaneous retrieval of a left-ventricularly embolized LAmbre occluder followed by same-session redo left atrial appendage closure: a case report
TL;DR
This case illustrated that, in carefully selected haemodynamically stable patients without valvular entrapment, left ventricular outflow tract obstruction, or structural injury, retrograde transaortic percutaneous retrieval of a left-ventricularly embolized LAAC device may be feasible.
Abstract
Abstract Background Left atrial appendage closure (LAAC) is an established stroke-prevention strategy for selected patients with atrial fibrillation who are unsuitable for long-term oral anticoagulation. Device embolization is rare but potentially life-threatening, particularly when the occluder migrates into the left ventricle, where it may interfere with the mitral or aortic valve apparatus or provoke ventricular arrhythmia. Case summary A 68-year-old woman with permanent atrial fibrillation, recurrent gross haematuria during anticoagulant therapy, chronic heart failure, and a high thromboembolic risk underwent LAAC under transoesophageal echocardiographic guidance. Pre-procedural imaging showed a left atrial appendage ostium of 30 mm, a landing-zone diameter of 28 mm, and a depth of 32 mm. During the first deployment attempt with a 28-/34-mm LAmbre occluder, the device showed insufficient anchoring and was not released. During attempted recapture and exchange, the partially deployed device embolized across the mitral valve into the left ventricular cavity, with a short self-terminating episode of ventricular tachycardia. Because the patient remained haemodynamically stable and real-time imaging showed no valvular entrapment or structural injury, retrograde transaortic percutaneous retrieval was performed using a 14-Fr steerable sheath and grasping forceps. After successful retrieval and immediate confirmation of valve integrity, a larger 32-/36-mm LAmbre occluder was implanted in the same session with stable position and no residual peri-device leak. Discussion This case illustrated that, in carefully selected haemodynamically stable patients without valvular entrapment, left ventricular outflow tract obstruction, or structural injury, retrograde transaortic percutaneous retrieval of a left-ventricularly embolized LAAC device may be feasible. The same-session redo LAAC can be considered after successful retrieval when valve integrity is confirmed and the left atrial appendage anatomy remains suitable.