From: A review of the LARIAT device: insights from the cumulative clinical experience
Complication | Cause | Preventative strategy |
---|---|---|
Pericardial effusion | Initial TSP Guide wire or catheter trauma to LAA after TSP Manipulation of delivery system in pericardium Pericardial access | TEE guidance Avoidance of severe IAS tenting Advancement of trans-septal sheath dilator into LAA under fluoroscopy over 0.32″ wire with distal curve on coronary wire TEE surveillance for RV compression with sheath advancement to avoid RV abrasion Micro-puncture access needle Placement of a ‘bail out’ wire in the pericardium for quick pericardial drain placement |
LAA laceration or perforation | LARIAT advancement and deployment | Cognizance of endocardial and epicardial wire forces on LAA Minimization of LARIAT delivery system prolapse onto LA Careful suture tightening |
Procedural stroke | LAA thrombus Insufficient AC Air embolus | Careful baseline TEE Close AC monitoring Careful flushing of trans-septal sheath |
Vascular complications | Hematoma, arterio-venous fistula, pseudoaneurysm, bleeding, hematoma | Careful technique with ultrasound guidance as needed |