Device‐in‐device: A transcatheter alternative to surgical explantation of a failing atrial septal defect intracardiac prosthesis

A failing intracardiac device is traditionally addressed by open‐heart surgery. Surgical explantation of the device, although a simple procedure, carries risks that some patients are not able or willing to cope with. Thus, a nonsurgical option seems desirable in selected cases. We report on four cases of early malfunction of the Polyvinyl Alcohol membrane of Ultrasept II™ CARDIA ASD devices. In all cases, transthoracic echo (TTE) surveillance 4–6 months after the index procedure, depicted significant left‐to‐right atrial shunts through the center portion of the devices. A second nitinol double disk device with a connecting pin (Lifetech CERA™ Multifenestrated ASD device) was implanted over the CARDIA devices, with excellent results. All procedures were uneventful and all patients are asymptomatic with no residual shunts, in short‐term follow‐up. This device‐in‐device technique prevents surgical explantation of failing ASD devices, and may become a less invasive option in selected patients. © 2016 Wiley Periodicals, Inc.