Healing condition of WATCHMAN surface 2.5 years after implantation observed in cardiac surgery

Abstract

Figures

A](#ytae198-F1)* and *[B](#ytae198-F1)* and Supplementary material online, *Video S1*). Mitral valve repair was electively performed 934 days post-LAAC. Intraoperative findings showed white and reddish-brown tissue enveloping the superior edge of the device, with the mitral annulus side remaining exposed (*[Figure 1C](#ytae198-F1)* and *[D](#ytae198-F1)* and Supplementary material online, *Video S2*). Post-operatively, warfarin was administered for three months, with aspirin reintroduced thereafter. A computed tomography at 10 months post-surgery displayed contrast enhancement within the left

Full text

A 74-year-old female with paroxysmal atrial fibrillation underwent successful left atrial (LA) appendage closure (LAAC) using a 27 mm WATCHMAN device (Boston Scientific, Marlborough, MA, USA), chosen based on a maximal ostial diameter of 22.0 mm measured by transoesophageal echocardiography (TEE) (see Supplementary material online, Supplementary Video S1). She was prescribed a combination of aspirin and rivaroxaban for 45 days post-LAAC, followed by dual antiplatelet therapy with aspirin and clopidogrel for six months. Aspirin monotherapy commenced thereafter. At the 45-day follow-up, TEE revealed no evidence of thrombus formation or peri-device leakage; however, endothelialization of the device surface was indeterminate (see Supplementary material online, Supplementary Videos S2 and S3). Concurrently, mitral regurgitation progressed to a severe condition and surgical intervention was considered. Two months prior to surgery, TEE indicated partial endothelial coverage at the device’s superior edge but not on the mitral annulus side (Figure 1A and B and Supplementary material online, Video S1). Mitral valve repair was electively performed 934 days post-LAAC. Intraoperative findings showed white and reddish-brown tissue enveloping the superior edge of the device, with the mitral annulus side remaining exposed (Figure 1C and D and Supplementary material online, Video S2). Post-operatively, warfarin was administered for three months, with aspirin reintroduced thereafter. A computed tomography at 10 months post-surgery displayed contrast enhancement within the left atrial appendage, suggesting incomplete device endothelialization (see Supplementary material online, Figure S1). The endothelialization timeline for WATCHMAN device is not fully understood, with various reports depicting the state of endothelialization post-deployment.^1–3^ Our case exhibited delayed endothelialization, persisting 2.5 years following device.

Supplementary Material

ytae198_Supplementary_Data