The WATCHMAN Implant is a one-time implant typically performed under general anesthesia with Transesophageal echo guidance (TEE). Similar to a stent procedure, the device is guided into the heart through a flexible tube (catheter) inserted through the femoral vein in the upper leg. The implant is introduced into the right atrium and is then passed into the left atrium through a puncture hole. These small iatrogenic atrial septal defects usually disappear within six months. Once the position is confirmed, the implant is released and is left permanently fixed in the heart. The implant does not require open heart surgery and does not need to be replaced. Recovery typically takes twenty-four hours.
The patient continues taking warfarin with aspirin for 45 days post implantation at which point in time they return for a transesophageal echocardiography to judge completeness of the closure and the presence of blood clots. If the seal is complete (no gaps around the device larger than 5mm with communication to the appendage), then the patient can stop taking warfarin and start clopidogrel and aspirinfor 6 months after implant. At 6 months post implantation, it is recommended for the patient to continue taking aspirin indefinitely. In the PREVAIL clinical trial, 92% of patients stopped taking warfarin after 45 days and 99% discontinued warfarin at 1 year