{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T20:15:17Z","timestamp":1771964117101,"version":"3.50.1"},"reference-count":10,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T00:00:00Z","timestamp":1612224000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Transseptal access for large sheaths may be encumbered by tissue resistance against the sheath\u2013dilator stepped interface. The ExpanSure Large Access Transseptal Dilator (Baylis Medical) is designed as a single introducer and dilation device with a smooth sheath\u2013dilator transition to support transseptal puncture. It may facilitate ease and efficiency of interatrial crossing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study experimentally evaluated the crossing force of ExpanSure relative to a conventional 8.5\u2009F Swartz SL1 transseptal sheath and dilator in a benchtop septum model. Its ability to reduce the subsequent crossing force of a 14\u2009F WATCHMAN delivery sheath was also tested. The clinical use of ExpanSure, including procedure time, was then validated in a series of left atrial appendage closure (LAAC) procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In a benchtop septum model (<jats:italic>N<\/jats:italic>\u2009=\u200912), less peak force (1.90\u2009\u00b1\u20090.08\u2009N vs. 2.36\u2009\u00b1\u20090.09\u2009N; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and overall work (17.3\u2009\u00b1\u20091.2\u2009mJ vs. 28.0\u2009\u00b1\u20091.9\u2009mJ; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) were required to advance ExpanSure relative to a conventional SL1 transseptal sheath and dilator system. Peak force (2.34\u2009\u00b1\u20090.24\u2009N vs. 2.65\u2009\u00b1\u20090.21\u2009N; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.003) and overall work (28.5\u2009\u00b1\u20093.9\u2009mJ vs. 35.4\u2009\u00b1\u20092.1\u2009mJ; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) to advance a WATCHMAN sheath were also significantly lower after using ExpanSure than after using a conventional transseptal system. In 19 LAAC procedures, ExpanSure crossed the septum smoothly and integrated readily, which enabled efficient procedure completion (mean total procedure time 37.6\u2009\u00b1\u200913.5\u2009min), with 100% success and no procedure\u2010related complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Experimental force measurements, combined with early clinical experience using ExpanSure, suggest that the tapered design with smooth transition without dilator\u2013sheath step\u2010up and the larger diameter, both facilitated ease and efficiency of interatrial crossing.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.14903","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T20:13:21Z","timestamp":1611260001000},"page":"729-734","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A new transseptal solution for enabling left atrial access of large delivery sheaths"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7889-2083","authenticated-orcid":false,"given":"Taku","family":"Inohara","sequence":"first","affiliation":[{"name":"Division of Cardiology, Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Gilhofer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saja","family":"Al\u2010Dujaili","sequence":"additional","affiliation":[{"name":"Regulatory and Scientific Affairs, Baylis Medical Company Baylis Medical Company Toronto Mississauga Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linus","family":"Leung","sequence":"additional","affiliation":[{"name":"Regulatory and Scientific Affairs, Baylis Medical Company Baylis Medical Company Toronto Mississauga Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darwin","family":"Yeung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Tsang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7027-984X","authenticated-orcid":false,"given":"Jacqueline","family":"Saw","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,2,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2010.01987.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eun013"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2008.01233.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810320409"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.04.032"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000428"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.10.035"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12730"},{"key":"e_1_2_7_10_1","first-page":"E17","article-title":"A useful trick for difficult transseptal access during cryoballoon ablation for atrial fibrillation","volume":"26","author":"Conte G","year":"2014","journal-title":"J Invasive Cardiol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2010.01973.x"}],"container-title":["Journal of Cardiovascular 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