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 concernKey differences between Watchman and Amulet devicesWatchman Flex and Flex Pro: reduced leak rates and improved safetyThe role of ICE vs TEE in modern workflowsTips on device sizing, oversizing, and how to avoid DRTWhen to intervene (and when to observe)Use of TrueSteer and the shift toward minimalist proceduresIf you’re a structural heart or interventional cardiologist, this is a must-watch to help guide your clinical decision-making and device selection.Follow the MurmurMD YouTube channel for more expert content: / @murmurmd Download the MurmurMD app here: https://apps.apple.com/app/apple-stor...#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