Successful Retrieval of a Disconnected WATCHMAN FLX in the Access Sheath Using an Endomyocardial Bioptome

A woman in her 80 s with atrial fibrillation was referred for percutaneous left atrial appendage (LAA) closure (LAAC) due to a high risk of cardioembolic stroke and bleeding. The LAA measured 29.3 mm on transesophageal echocardiography (Figure A). Thus, LAAC was performed using a 35-mm WATCHMAN FLX (Boston Scientific, Marlborough, MA, USA; Figure B). However, deploying the device to the appropriate position proved difficult (Figure C). Frequent anticlockwise rotations and recaptures were attempted; thereafter, the device was completely disconnected from the core wire in the access sheath, despite making a “FLX-ball” (Figure D,E).

Figure.

Retrieval of a disconnected WATCHMAN FLX device. (A) Transesophageal echocardiographic measurement of the left atrial appendage entry orifice. (B,C) Although percutaneous left atrial appendage closure was performed, the device was not deployed in an appropriate position. (D,E) After frequent recapture attempts, the disconnected device was located in the access sheath, despite making a “FLX ball”. (F,G) Failure to grasp the device using 7- and 0–40-mm gooseneck snare catheters. (H–J) Successful retrieval of the device using an endomyocardial bioptome.

To recapture the completely separated device, we attempted to grasp the proximal site using 7- and 0–40-mm gooseneck snare catheters (Figure F,G). This approach failed several times because it was difficult to slide the snare over the device due to its smooth surface. Subsequently, we attempted to retrieve the device using an endomyocardial bioptome (Cordis, Cardinal Health, Milpitas, CA, USA). The bioptome was carefully advanced under the guidance of fluoroscopy, and transesophageal echocardiography imaging confirmed that the device was pressing against the LAA wall, preventing it from detaching from the access sheath (Figure H,I). The device was retrieved by rocking its metal screw using the endomyocardial bioptome (Figure J; Supplementary Movie). Finally, a 35-mm WATCHMAN FLX was successfully deployed without any further complications. An alternative technique is to reconnect the device by screwing clockwise. If this method is ineffective, device retrieval using a bioptome can be considered, depending on the situation.

This paper reports a rare complication of disconnection of a WATCHMAN FLX from the delivery cable. After frequent attempts to recapture the device during LAAC, an endomyocardial bioptome, rather than a snare catheter, helped resolve this complication.

Supplementary Files

Supplementary Movie. The disconnected device was successfully retrieved using an endomyocardial bioptome.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circrep.CR-22-0016