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\begin{document}

\title{Percutaneous Extraction of a Migrated Watchman Device After 7 Months}



\author[1]{Abhishek Maan}%
\author[1]{Mohit turagam}%
\author[1]{Srinivas Dukkipati}%
\author[2]{Vivek Reddy}%
\affil[1]{Icahn School of Medicine at Mount Sinai}%
\affil[2]{Mount Sinai School of Medicine}%


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  \date{May 23, 2024}


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\begin{abstract}
An 84-year-old man with persistent AF (CHA2DS2-Vasc 6) was referred
because of a migrated 24-mm Watchman implanted 7 months prior.
Transesophageal echo (TEE) showed device malposition and protrusion
outside the LAA along with a 90\selectlanguage{ngerman}º tilt and peri-device leak (Figure,
Movies 1-3). Under general anesthesia, an extraction was performed using
TEE, intracardiac echocardiographic and fluoroscopy. Using a femoral
arterial approach, a 27-mm Watchman was positioned in ascending aorta
for cerebroembolic protection, never released from the connecting wire
(WAASP technique, Movies 4-5) (1). A 23-Fr non-deflectable sheath
(Micra, Medtronic, MN) was advanced into right atrium, through which a
12-Fr deflectable sheath (Flexcath Advance, Medtronic) was placed
transeptal. A 2.4 mm x 20 cm Raptor grasping device (US Endoscopy,
Mentor, Ohio; Figure) was advanced through 12 Fr sheath to grasp the
Watchman device. With sustained traction, the device was dislodged from
the LAA into the 23 Fr sheath (Figure, Movie 6). A new 24 mm Watchman
was then placed and the temporary Watchman in the aorta was removed. A
follow up TEE showed stable position without significant peri-device
leak. This case demonstrates the safety and feasibility of malpositioned
Watchman extraction re-implantation in the same setting (2).%
\end{abstract}\selectlanguage{ngerman}%



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