Retro-Curve Access Sheath for Retroverted Anatomy in Left Atrial Appendage Closure: Bench Validation and Patient-Specific Simulation Study.

•Left atrial appendage (LAA)-Print registry analysis identified 22 retroverted LAA anatomies treated with WATCHMAN.•Retro LAA was associated with high rates of off-axis deployment, leak, and failure.•All 22 cases underwent bench testing using soft patient-specific atrial models.•Double-curve and steerable sheaths remained noncoaxial despite puncture optimization.•A newly designed retro-curve sheath restored axial alignment regardless of puncture site.