Surgical vs TranscatheterJACCFriday, August 28, 2026

Retrieval Strategies for Embolized Left Atrial Appendage Closure Devices.

1 min read·By E. Nolan Beckett, MD·Source: JACC. Case reports

From The Valve Wire

This case series describes four LAAO device embolizations managed with distinct retrieval strategies: open surgical retrieval with AtriClip for an endothelialized device, sequential transseptal-then-retrograde arterial snaring for intraprocedural aortic migration, dedicated transseptal ONO-system retrieval with cerebral embolic protection, and retrograde large-bore arterial retrieval for delayed aortic embolization.

All four illustrate that location-tailored percutaneous retrieval is feasible, but surgical backup remains essential.

This is a case series — no denominator, no comparator, no outcome data beyond the reported successes.

Publication bias in case reports of rare complications is near-total: the failed retrievals don't make it into print.

Source Abstract

BACKGROUND: Device embolization (DE) is a rare but potentially life-threatening complication of left atrial appendage occlusion (LAAO). As landmark trials broaden the eligible population for LAAO, operator preparedness for DE management becomes increasingly critical. CASE SUMMARY: We present 4 cases of LAAO DE managed with distinct retrieval strategies: 1) open surgical retrieval with concurrent AtriClip ligation for an endothelialized left atrial device; 2) sequential transseptal then retrograde arterial snaring for intraprocedural migration to the abdominal aorta; 3) transseptal retrieval using a dedicated ONO system with cerebral embolic protection for partial left atrial dislodgment; and 4) retrograde large-bore arterial retrieval for delayed aortic embolization. CONCLUSIONS: Percutaneous retrieval is feasible in most cases when tailored to embolization location. Surgical backup remains indispensable. Prevention requires rigorous preprocedural imaging, accurate sizing, and routine postimplant surveillance. TAKE HOME MESSAGE: LAAO embolization has high mortality, accurate device sizing as well as follow up imaging in paramount.