Left atrial appendage occlusion with Watchman device after incomplete surgical ligation

Abstract

Non-valvular atrial fibrillation (NVAF) is the most common cause of cardioembolic stroke. The left atrial appendage (LAA) is the major source of cardiac emboli in patients with NVAF. Anticoagulation (AC) is the standard of care for stroke prevention in atrial fibrillation (AF), but many patients are intolerant of AC. Surgical exclusion of the LAA may result in incomplete closure and is associated with an increased risk of embolism. We report a case of a woman in her 50s with a history of persistent AF, mitral valve prolapse s/p repair with surgical LAA exclusion, and multifocal haemorrhagic stroke presented for elective LAA closure who underwent a Watchman placement successfully. This case demonstrates that a percutaneous approach for occlusion of the LAA when surgical exclusion was incomplete may be feasible with appropriate planning. Clinical outcome data for this patient group are needed.

The use of percutaneous left atrial appendage occluder device in a patient with prior surgical ligation with incomplete exclusion: a case report

“… 7 Prior studies have suggested 20–40% rate of incomplete surgical LAA ligation. 3 , 8 In such cases, patients with high bleeding risk should have percutaneous options available to them, which offer a lower risk therapy for minimizing risk of LAA thrombus. Despite their therapeutic indications, LAAO devices carry a risk of complication, primarily including device thrombosis, bleeding from post-procedural anticoagulation use, post-operative pericardial effusions, and post-procedural stroke.…”

“… 5 , 6 Although studies have analysed the use of percutaneous measures such as coils, plugs, or second occluder device deployment in LAA with peri-device leak (PDL), 7 use of percutaneous occlude devices in surgically occluded LAA is far less studied. 8 , 9 We present a case of LAAO device deployment within a surgically occluded LAA with PDL.…”

Acute thrombus formation on the delivery sheath during left atrial appendage occlusion: Case reports with placement of cerebral protection devices

“…Intraprocedural thrombosis during LAAO has been rarely reported. A case report firstly described the acute thrombus formation on the surface of the occlusion device immediately after release 6 . The patient's recent COVID‐19 infection may contribute to acute thrombus formation.…”

“…A case report firstly described the acute thrombus formation on the surface of the occlusion device immediately after release. 6 The patient's recent COVID-19 infection may contribute to acute thrombus formation. Thrombus formation on the delivery sheath during LAAO has been reported.…”