All Leaks Matter? Re-Thinking Peri-Device Leak Significance in LAA Closure with Dr. Michael Rinaldi

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The Murmur Pod

MurmurMD

22 episodes

6 days ago

The Murmur Pod is hosted by Dr. Aidan Raney III and Dr. Joe Walsh. Specializing in interventional cardiology, they explore happenings in the cardiology and medical communities, discuss interesting cases, review new technology, and more. This podcast is presented first in the MurmurMD App! Work in the cath lab? Reach out to join the private community there!

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All Leaks Matter? Re-Thinking Peri-Device Leak Significance in LAA Closure with Dr. Michael Rinaldi

The Murmur Pod

22 minutes 17 seconds

4 months ago

All Leaks Matter? Re-Thinking Peri-Device Leak Significance in LAA Closure with Dr. Michael Rinaldi

Do all leaks matter in Left Atrial Appendage Closure?

Dr. Michael Rinaldi, Director of Structural Heart at Sanger Heart & Vascular Institute, offers a deep dive into the evolving science of peri-device leaks during LAAC. In this insightful discussion, he explores which leaks carry stroke risk, how device technology is changing the game, and what imaging and sizing strategies are most effective.

Topics covered include:

Stroke risk: how much do small leaks actually increase it?

Why leaks over 3mm are the new threshold of concern

Key differences between Watchman and Amulet devices

Watchman Flex and Flex Pro: reduced leak rates and improved safety

The role of ICE vs TEE in modern workflows

Tips on device sizing, oversizing, and how to avoid DRT

When to intervene (and when to observe)

Use of TrueSteer and the shift toward minimalist procedures

If you’re a structural heart or interventional cardiologist, this is a must-watch to help guide your clinical decision-making and device selection.

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#Cardiology #LAAC #Watchman #TEE #ICE #StructuralHeart #CathLab #strokeprevention

00:00 Introduction by Dr. Elliot Groves

00:18 Dr. Michael Rinaldi Joins the Discussion

00:50 Do All Leaks Really Matter?

01:36 Stroke Risk with Small Peri-Device Leaks

02:21 Understanding Leak Size and Stroke Magnitude

03:05 Types of Device Leaks Explained

04:03 Device Differences: Watchman vs Amulet

05:23 Confounders in Stroke Risk Assessment

06:09 Should We Intervene on Small Leaks?

06:43 Why 3mm Is the New Leak Cutoff

07:07 Clinical Significance of Small Crescentic Leaks

07:40 How Watchman Flex Changed Leak Rates

08:10 Data from PROTECT, OPTION, and CHAMPION Trials

08:39 The Future of Imaging: ICE vs TEE

09:32 Minimalist Workflow and Resource Constraints

10:19 Better Imaging, Better Devices: What’s Next?

10:36 Summary: Which Leaks Matter Most?

11:13 Deployment Tips to Minimize Leaks

12:10 When to Intervene and When to Observe

13:04 Caution Against Overusing Coils and Plugs

14:04 Debating Device Oversizing Strategies

15:05 Oversizing vs Stability: Finding the Sweet Spot

16:35 Compression, DRT, and the Ice Cream Cone Effect

17:11 Where TruSteer Makes a Difference

18:02 Why Watchman Flex Works for Most Appendages

20:08 Final Thoughts on Device Selection

21:30 Closing Remarks and Community Discussion