Successful left atrial access through GORE CARDIOFORM ASD occluder using an integrated transseptal wire system after failed RF needle approach

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  FIGURE 1. Sequential approach to transseptal access through GORE ASD occluder (LAO 55° view). (A) Transseptal puncture using RF needle: Initial transseptal puncture attempt using radiofrequency (RF) needle. Although the RF needle tip successfully penetrated the ASD occluder device, the outer sheath could not be advanced beyond the occluder material. (B) Integrated transseptal wire approach. Introduction of an integrated transseptal wire (AccuSafe® system) following unsuccessful sheath advancement with the RF needle. The integrated transseptal wire passes through the ASD occluder device. (C) 8.5‐Fr sheath advancement in occluder. Advancement of an 8.5‐Fr SL0 sheath through the occluder using the integrated wire system. (D) 1 puncture, 2 sheath” technique. “1 puncture, 2 sheath” technique: Sequential advancement of 8.5‐Fr SL0 sheath to enlarge the puncture site through the GORE occluder. (E) 12‐Fr cryosheath advancement in the GORE occluder. Successful advancement of a 12‐Fr cryoballoon sheath through the GORE occluder. (F) Final cryosystem image after transseptal through the GORE occluder. Final positioning of the cryoballoon system in the left atrium after transseptal access through the…

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  FIGURE 2. AccuSafe® integrated transseptal puncture wire system demonstration in porcine model. (A) Initial tenting of the atrial septum with an 8.5‐Fr sheath; the wire has just begun to cross the septum but remains in a straight configuration. (B) J‐shaped transformation of the wire tip after successful penetration of the atrial septum. (C) Advancement of the wire alone through the ventricular septum, showing full J‐tip formation. (D) Advancement of both the wire and the sheath through the ventricular septum.