How to anticipate a complex left atrial appendage closure intervention?

So Nina, the, the first question that I would like to ask you is that we've been, for many years, we've been using, you know, this old classification of chicken wings, cactus, windsocks.

So these parameters are really important.

What are the par- parameters that really matter, you know, now, when we're closing an appendage?

Yeah, Xavi.

I mean, it wasn't really helpful in telling us, uh, if a procedure is really challenging.

Yeah? We knew if you have a cauliflower morphology, we might have some more thrombi in the left atrial appendage.

Or if you have a Sanford, for example, you knew, well, you might have, or you might need a specific technique to close, uh, the left atrial appendage.

But it didn't really tell us if you are facing a challenging procedure.

So that's why we did some efforts and try, uh, to collect parameters, which are really important and which can really influence, uh, uh, your procedural strategy or device selection, uh, which could tell you that this procedure might be a more challenging one than a simple one.

So the parameters which we included in a framework, which is a European left atrial appendage, uh, closure classification.

So we included a couple of parameters.

So first of all, entrance, ELAC, is, uh, the first, uh, letter.

So, uh, entrance, which it stands for the ostium.

So a couple of parameters concerning the ostium.

The next group of parameters is addressing the landing zone.

What is important? Do we have out-pouchings? Do we have protuberances, uh, within the landing zone which could make, uh, a procedure more challenging? Um, then we have the major axis, which is important if it's more anterior or posterior because this might tell you where your transseptal puncture site should be.

And, uh, we, um, also address the oval anatomy.

If you have a short desk, that could be a problem.

So a lot of parameters which are really clinically impactful.

In addition also contractility, which could contribute to a higher rate of, uh, um, embolization or erosion.

So I think it's a framework which really helps to look closely at the anatomy of the left atrial appendage, and which could tell you, um, this might be a procedure which is a little bit more challenging.

But, uh, Xavi, if you're just looking at the anatomy, it might be not enough to determine if this is a really challenging procedure.

So what else has to be taken into consideration concerning a challenging procedure?