First-in-Human Experience of Using a Universal Steerable Sheath in Implanting Left Atrial Appendage Closure Devices

Sheng-Nan Chang; Fu-Chun Chiu; Jien-Jiun Chen; Pang-Shuo Huang; Ting-Tse Lin; Hsiao-Liang Cheng; Chin-Feng Tsai; Yi-Chih Wang; Chia-Ti Tsai

doi:10.1016/j.jacasi.2022.08.003

First-in-Human Experience of Using a Universal Steerable Sheath in Implanting Left Atrial Appendage Closure Devices

JACC Asia. 2022 Nov 15;2(6):780-783. doi: 10.1016/j.jacasi.2022.08.003. eCollection 2022 Nov.

Authors

Sheng-Nan Chang¹, Fu-Chun Chiu¹, Jien-Jiun Chen¹, Pang-Shuo Huang¹, Ting-Tse Lin², Hsiao-Liang Cheng³, Chin-Feng Tsai⁴, Yi-Chih Wang⁵, Chia-Ti Tsai⁵

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Ling Branch, Dou-Liu City, Taiwan.
² Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan.
³ Department of Anesthesiology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
⁴ School of Medicine, Chung Shan Medical University; Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁵ Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.

Abstract

Left atrial appendage (LAA) closure (LAAC) device implantation may be challenging in cases with difficult LAA anatomy. A deflectable sheath to approach multiple LAA positions may be helpful. We used a deflectable sheath to implant LAAC devices in 20 patients and included 60 cases using the standard sheaths for comparison. The procedures were successful in all patients without peri-procedural complications. After a median follow-up of 1.52 (IQR: 0.76-2.33) years, none of the patients in the deflectable sheath group had peri-device leak ≥3 mm and experienced thromboembolic stroke. In the standard sheath group, after follow-up of 2.03 (IQR: 0.87-3.19) years, 2 had peri-device leak ≥3 mm and 1 experienced thromboembolic stroke. We first proved the idea of using a universal steerable sheath for LAAC device implantation in difficult LAA anatomy, which also allows rapid switching of different LAAC devices.

Keywords: AF, atrial fibrillation; LAA, left atrial appendage; LAAC, left atrial appendage closure; deflectable sheath; left atrial appendage closure device; steerable sheath.