Retrieval Strategies for Embolized Left Atrial Appendage Closure Devices.

BACKGROUND

Device embolization (DE) is a rare but potentially life-threatening complication of left atrial appendage occlusion (LAAO). As landmark trials broaden the eligible population for LAAO, operator preparedness for DE management becomes increasingly critical.

CASE SUMMARY: We present 4 cases of LAAO DE managed with distinct retrieval strategies: 1) open surgical retrieval with concurrent AtriClip ligation for an endothelialized left atrial device; 2) sequential transseptal then retrograde arterial snaring for intraprocedural migration to the abdominal aorta; 3) transseptal retrieval using a dedicated ONO system with cerebral embolic protection for partial left atrial dislodgment; and 4) retrograde large-bore arterial retrieval for delayed aortic embolization.

CONCLUSIONS

Percutaneous retrieval is feasible in most cases when tailored to embolization location. Surgical backup remains indispensable. Prevention requires rigorous preprocedural imaging, accurate sizing, and routine postimplant surveillance.

TAKE HOME MESSAGE: LAAO embolization has high mortality, accurate device sizing as well as follow up imaging in paramount.