Abstract
Background
Transcatheter left atrial appendage occlusion (LAAO) is a low-risk procedure with a <1.0% risk of malposition.
Case Summary
An 80-year-old man with atrial fibrillation intolerant to apixaban underwent implantation of a 24 mm Watchman FLX device (Boston Scientific), which immediately shifted, exposing uncovered metal in the left atrium. Four weeks later, an AngioVac F22180 catheter (AngioDynamics) was advanced into the left atrium and a 10-mm Raptor grasping forceps (Steris) was introduced via the AngioVac catheter. Using the Raptor, the Watchman FLX was grasped and with cautious, sustained force extracted into the AngioVac (Video 1) and out of the body intact (Figure 1). A 28 mm Amulet device (Abbott) was then implanted.
Discussion
While alternative approaches to LAAO device retrieval have been described, this is to our knowledge the first report describing the use of an AngioVac catheter to extract a malpositioned Watchman FLX (Video 2) and achieving successful LAAO by replacement with an Amulet.
Take-Home Message
Implanting proceduralists must be equipped to salvage high-risk complications such as device malposition.
Graphical Abstract
Figure 1.
Percutaneously Extracted Watchman FLX Device
The Watchman FLX device (blue arrow) grasped with the Raptor (green arrow) is shown after extraction using the AngioVac catheter (red arrow).
Funding Support and Author Disclosures
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Footnotes
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 Author Center.
For supplemental videos, please see the online version of this paper.
Appendix
Video File With Revised Slide Set
Percutaneous Extraction of a Malpositioned Watchman FLX Device
Extraction of a malpositioned Watchman FLX device (Boston Scientific) from the left atrial appendage using a Raptor grasping forceps (Steris) introduced via an AngioVac catheter (AngioDynamics).
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Video File With Revised Slide Set
Percutaneous Extraction of a Malpositioned Watchman FLX Device
Extraction of a malpositioned Watchman FLX device (Boston Scientific) from the left atrial appendage using a Raptor grasping forceps (Steris) introduced via an AngioVac catheter (AngioDynamics).