A bend in time: Shaping the sheath facilitates left atrial appendage closure

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.