Key result
Shape-the-sheath technique cuts fluoroscopy time by ~47% during LAA closure, with fewer partial recaptures.
Why the study?
Left atrial appendage occlusion is challenging due to the variable three-dimensional anatomy and learning curve, necessitating improved procedural methods.
Does the 'shape-the-sheath' method improve procedural efficiency and reduce recaptures in patients undergoing left atrial appendage closure?
Cohort (n=20)
Does the 'shape-the-sheath' method improve procedural efficiency and reduce recaptures in patients undergoing left atrial appendage closure?
Shaping the delivery sheath during left atrial appendage occlusion significantly reduces fluoroscopy time and the need for device recaptures, optimizing procedural efficiency.
Answers are grounded in this paper and cite their sources.
Shape-the-sheath may be feasible for LAA closure; hypothesis-generating and requires prospective validation before adoption.
OBJECTIVES: The purpose of this study is to determine feasibility, safety, and effectiveness of the "shape-the-sheath" method in left atrial appendage closure. BACKGROUND: LAA occlusion is often a difficult procedure, due to not just the learning curve but also the three-dimensional variable nature of the left atrial appendage. Multiple sheaths have been created for various takeoffs. The purpose of this article is to show the feasibility of the "shape-the-sheath" method in left atrial appendage closure. METHODS: Ten consecutive patients undergoing LAA occlusion without the "shape-the-sheath" method were compared to 10 consecutive patients undergoing LAA occlusion with the "shape-the-sheath" method using the Amplatzer Cardiac Plug (ACP) system and the Amplatzer TorqVue 45×45 sheath. RESULTS: The "shape-the-sheath" method resulted in significant decreases in fluoroscopy time (7.2±3.0 min vs. 13.7±6.7 min, P<0.05), number of partial recaptures (0% vs. 50%, P<0.05), with a trend toward decrease in the number of complete recaptures (0 vs. 40%, P=0.09) compared to conventional sheath use. CONCLUSIONS: Shaping-the-sheath is a simple, elegant way to help conform delivery systems to better access the LAA and ensure stable position. Further experience with this procedure optimization step is warranted.
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Gafoor et al. (2015) conducted a cohort in Left atrial appendage closure (n=20). "shape-the-sheath" method vs. Conventional sheath use was evaluated on Fluoroscopy time (minutes) (p=<0.05). The 'shape-the-sheath' method for left atrial appendage closure decreased fluoroscopy time and partial recaptures.
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