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Retrieval of large Occlutech Figula Flex septal defect occluders using a commercially available bioptome: proof of concept

Published online by Cambridge University Press:  21 May 2018

Stanimir Georgiev ,
Daniel Tanase ,
Thomas Genz ,
Peter Ewert ,
Susanne Naumann ,
Robert Dalla Pozza  and
Andreas Eicken
Stanimir Georgiev*
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
Daniel Tanase
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
Thomas Genz
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
Peter Ewert
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
Susanne Naumann
Affiliation:
Experimental and Molecular Pediatric Cardiology, German Heart Center Munich at the TU Munich, Munich, Germany
Robert Dalla Pozza
Affiliation:
Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian-University, Munich, Germany
Andreas Eicken
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
*
Author for correspondence: S. Georgiev, Department for Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Lazarettstrasse 36, 80636 Munich, Germany. Tel: +49 89 1218 2740; Fax: +49 89 1218 4313; E-mail: georgiev@dhm.mhn.de
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Abstract

Objectives

This study aimed to develop a method for retrieval of the new meshed nitinol atrial septal defect occluders – Ceraflex and Occlutech.

Background

The newly developed atrial septal defect occluders have potential benefits considering implantation, but concerns regarding their removal in case of embolisation have been raised.

Methods

Over 21 years, 1449 patients underwent interventional atrial septal defect occlusion in our institution. We reviewed the cases of embolisation of the device, developed a strategy for device removal, and tested it on the benchside and in animal tests.

Results

In 11 patients (0.8%), the intended atrial septal defect occlusion was complicated by an embolisation of the device. In contrast to the Amplatzer septal occluders, retrieval of Occlutech devices larger than 16 mm with snare techniques was impossible. In benchside tests, this was confirmed and a new method for removal of large meshed devices was developed. This involved the commercially available Maslanka® biopsy forceps. The feasibility of this technique in vivo was tested in a pig model. During animal tests, using the Maslanka biopsy forceps it was possible to interventionally retrieve embolised Ceraflex and Occlutech devices of different sizes – 10, 16, 30, and 40 mm – into a 12-F sheath.

Conclusion

It was impossible to retrieve Occlutech and Ceraflex devices larger than 16 mm into a large sheath in vivo and during benchside tests. However, this was feasible on the bench and in vivo using the Maslanka biopsy forceps even with the largest available devices.

Keywords

ASD closuredevice embolisationdevice retrievalinterventional (stents, etc.)
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 7 , July 2018 , pp. 955 - 960
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Copyright
© Cambridge University Press 2018 

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