Po-03-161 intra-procedural crossover of left atrial appendage occlusion devices, a single center experience

Two devices are currently available for percutaneous left atrial appendage occlusion (LAAO), Watchman FLX and Amplatzer Amulet. While in most cases LAAO is achieved by implanting the originally planned device, intra-procedural crossover from one type to the other might be necessary when LAAO is not satisfactory. To evaluate the rate and characteristics of intra-procedural device crossover in LAAO procedure. All successful LAAO procedures performed in our center since October 2021 (Amulet’s FDA approval) are included in the study. Of note, LAAO procedures are performed under fluoroscopic and ultrasound (TEE or ICE) guidance, without formal preprocedural imaging planning. 365 patients (74±9 years; 34% female) underwent LAAO over 12 months. LAAO was successful in all but 1 case, in which the LAA was too large for successful implantation of the originally planned device (Watchman) and crossover was not attempted. In almost all cases (361/364, 99%), the original planned device was implanted successfully achieving complete LAAO (Watchman in 325 patients, Amulet in 34 patients). Intra-procedural device crossover was observed in 4 (1%) patients, all from Watchman to Amulet. In 3 cases, the LAA ostium and proximal LAA were large, leading to deployment of an undercompressed, unstable 35 mm Watchman device: Amulet allowed positioning of the lobe in a more distal, stable location with the disc covering the ostium (Figure, left panel). In 1 case, the LAA was of adequate size, but a proximal ridge (s/p LAA isolation) lead to Watchman deformation (struts’ introversion on one side) once fully deployed, a behavior observed despite multiple recaptures and a device change: with Amulet, the lobe could be placed distally to the ridge with the disc covering the ostium (Figure, right panel). Mean procedural time was 107±3 min, with a mean contrast volume used of 203±70 mL and a mean fluoroscopy time of 15±4 min (yielding to a mean dose of 2070±3107 mGy). There were no procedural-related complications, and all patients were discharged home after overnight observation. Intraprocedural LAAO device crossover is a rare occurrence, usually secondary to unsatisfactory deployment of the originally planned device. To avoid unsuccessful LAAO, operators should be skilled in implantation of both type of devices and be able to switch from one to the other at the time of the index procedure.Tabled 1PatientLAA os max diameterOriginal deviceFinal device131 mm35 mm Watchman FLX31-mm Amplatzer Amulet229 mm35-mm Watchman FLX34-mm Amplatzer Amulet329 mm35-mm Watchman FLX34-mm Amplatzer Amulet421 mm27-mm Watchman FLX22-mm Amplatzer Amulet Open table in a new tab