Surgical management of embolised occlude devices and its complications-Single centre experience of ten years at Grant Medical College, Mumbai, Maharashtra

Abstract

Introduction: In this study, we have analyzed our experience in surgical management of device embolization after trans-catheter closure of atrial septal defect [ASD] and its complications.

Method: This study is a review of 27 patients out of 300 patients who underwent transcatheter device closure of ASD between august 2007 to august 2017, in whom the device embellished and surgery was required for its retrieval and ASD closure. Risk factors for device embolization, its management and subsequent prognosis were discussed.

Results: Emergency device retrieval with pericardial patch closure of ASD on cardiopulmonary bypass was done in each case. Most common site for device embolization was right atrium. Other site of embolization are right ventricle, left atrium and even in pulmonary artery. More than half patients had inadequate rims, 3 patients had developed pericardial tamponade post cardiac perforation. Three patients developed femoral artery thrombosis at the catheter puncture site for which embolectomy was required. One patient developed transient ischaemic attack on postoperative day one. All other patients recovered well.

Conclusion: Closure of ostium secondum atrial septal defects by percutaneous occlude devices has significant advantages, however device embolization continues to be a major complication with chances of added morbidity of vascular complications, stroke and transient ischaemic attacks. Patient selection is of as much importance as device selection to prevent patient –device mismatch. After device embolization, the device can be retrieved and the septal defect can still be closed surgically with good success and minimal morbidity if acted upon on an urgent basis.