In this MurmurMD discussion, Dr. Raghava Gollapudi and Dr. Arvin Narula break down how the Watchman TruSteer sheath changes left atrial appendage occlusion (LAAO) workflows — from transeptal access to final device deployment.

The conversation focuses on real-world use, and highlights when TruSteer adds value, how it improves coaxiality, and why many operators are moving toward using it routinely.

Topics covered in this transcript-based discussion include:

• Why earlier Watchman sheaths limited depth and stability

• How TruSteer allows four-directional control (superior, inferior, anterior, posterior)

• Using the device body and sheath as complementary anchoring mechanisms

• Improving coaxial alignment without repeating transeptal puncture

• Why TruSteer reduces redeployments and manipulation

• Large anterior chicken-wing, flat, and posterior appendage anatomy

• Efficiency gains vs cost considerations

• Why some operators now use TruSteer in nearly every case

• Safety pearls: avoiding steering with the dilator in place

• Minimizing air and bubble risk by reducing sheath exchanges

• Achieving zero-leak goals in the Watchman FLX era

A practical discussion for operators looking to improve precision, safety, and efficiency in LAAO.

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Chapters:

00:00 – Introduction to Watchman TruSteer

00:40 – Limitations of earlier Watchman sheaths

01:40 – Four-directional steering and coaxial control

03:00 – Using the sheath vs the device body for positioning

04:10 – Challenging appendage anatomy: chicken-wing and posterior LAA

05:30 – Improving depth without repeating transeptal

06:40 – Efficiency, safety, and air management

08:00 – Cost vs value: when TruSteer adds benefit

09:20 – Zero-leak mindset in the FLX era

10:40 – Safety tips and final takeaways

#LAAO #LAAC #Watchman #TruSteer #StructuralHeart

#InterventionalCardiology #CathLab #MurmurMD

#WatchmanFLX #LeftAtrialAppendage