title: "A bend in time": Shaping the sheath facilitates left atrial appendage closure.
abstract: OBJECTIVE
  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.
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.|Swedish Medical Center, Seattle, WA, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Luisa
authors.initials: L
authors.lastname: Heuer
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schulz
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Predrag
authors.initials: P
authors.lastname: Matic
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.|Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Franke
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.|Department of Cardiology, Veterans Affairs Hospital, Minneapolis, Minnesota.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bertog
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Reinartz
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Vaskelyte
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Ilona
authors.initials: I
authors.lastname: Hofmann
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D015641:Radiography, Interventional; D016896:Treatment Outcome
keywords: access; amplatzer cardiac plug; occlusion