Po-03-136 percutaneous retrieval of acute amulet laa occluder malposition or dislodgement

Device embolization with the Amulet LAA occluder was rare (0.7%) in the Amulet IDE trial. Percutaneous techniques to retrieve embolized devices are poorly characterized. To describe a technique for percutaneous retrieval of malpositioned/embolized Amulet devices. We present 2 cases of acute Amulet malposition/embolization and subsequent percutaneous retrieval. Case 1: 78 y/o male with an electrically isolated LAA after AF ablation underwent LAAO with TEE guidance. The LAA landing zone width was measured as 29 mm, so a 31 mm Amulet was deployed uneventfully. A same-day echocardiogram revealed device dislodgement into the LA. Patient was brought back to the EP lab in stable condition. A retrieval system (23 Fr Micra sheath, Agilis steerable sheath and a Raptor forceps) was positioned in the right atrium (RA). Under TEE and fluoroscopic guidance, the Raptor catheter with the Agilis sheath was advanced into the LA through the Micra sheath and prior transseptal puncture. The Micra sheath was positioned to support the interatrial septum from the RA side, while the Raptor catheter and Agilis were used to capture the device and withdraw it into the RA, into Micra sheath and then removed from the body. Reassessment of the landing zone width led to successful deployment of a 25 mm Amulet. Case 2: 61 y/o female with ASD repair, prior AF ablations, two TIAs on anticoagulation underwent LAAO with ICE guidance. A 25 mm Amulet was deployed, but within minutes of deployment, the device acutely shifted in the LAA to a suboptimal position. A Raptor catheter was advanced via the Amulet steerable sheath into the LA, and the device was recaptured and brought into the RA; however, when trying to withdraw into the sheath, it disengaged from the Raptor catheter. Subsequently, the Amulet sheath was exchanged for the previously described retrieval system. The Amulet was recaptured in the RA, but due to unfavorable position, it couldn’t be brought into the Micra sheath. Another retrieval system was inserted into the RA via the contralateral femoral vein. One Raptor catheter was used to stabilize the Amulet, while the other one captured it in a favorable position and successfully withdrew into the Micra sheath. A 27 mm Watchman device was subsequently successfully implanted. Both patients were discharged from the hospital without other complications. Amulet dislodgement from the LAA is rare, but when it happens, it can be safely and effectively managed by percutaneous techniques.