Can you safely perform left atrial appendage occlusion (LAAO) without TEE, anesthesia, or an echo doc?
In this episode, Dr. Raghava Gollapudi (San Diego Cardiac Center) and colleagues break down how they built a conscious sedation, ICE-only LAAO program in private practice. They cover:
- Why traditional TEE + anesthesia models slow scheduling and add variability
- Evidence from Europe showing ICE-only Watchman is safe
- How to transition from TEE support to ICE-only workflow
- Practical pearls for ICE catheter handling, transeptal crossing, and imaging
- Patient selection: absolute and relative contraindications
- The role of nursing staff and team buy-in
- Why 3D/4D ICE makes device visualization easier
This is a must-watch for operators and program builders looking to simplify workflows and improve access to LAAO.
⏱️ Chapters
00:00 – Intro & program overview
01:00 – Why conscious sedation for LAAO?
02:00 – Limitations of TEE + anesthesia model
02:45 – Evidence for ICE-only Watchman safety
03:30 – Becoming a solo-operator with ICE
04:45 – Transition: 20 cases with TEE + ICE
06:00 – Patient selection: contraindications & risks
08:00 – Screening tools & nursing involvement
09:00 – Step-by-step ICE technique & home views
10:30 – Transeptal crossing: tips, 3-minute rule
12:00 – Biggest barrier: ICE-only septal crossing
14:00 – Imaging the appendage: mid & low angle views
15:45 – Benefits of 3D/4D ICE vs 2D ICE
16:30 – Final pearls for solo-operator LAAO
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