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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*
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
Daniel Tanase
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
Thomas Genz
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
Peter Ewert
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Munich, Germany
Susanne Naumann
Experimental and Molecular Pediatric Cardiology, German Heart Center Munich at the TU Munich, Munich, Germany
Robert Dalla Pozza
Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian-University, Munich, Germany
Andreas Eicken
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:



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


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


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.


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.


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.

Original Articles
© Cambridge University Press 2018 

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