Advances in electrosurgical techniques have helped thousands of transcatheter valve patients
Thousands of patients who once had no viable transcatheter options for severe heart valve disease are now receiving life-saving transcatheter valve therapies thanks to the growing adoption of innovative electrosurgical techniques.
Toby Rogers, MD, PhD, associate professor of medicine at Georgetown University and interventional cardiologist at MedStar Heart and Vascular Institute’s Structural Heart Disease Program, discussed the advances during the Electrosurgery Summit at the CRT 2025 meeting earlier this year, also speaking with Cardiovascular Business on these innovations.
“These procedures started with individual patients who weren’t eligible for standard therapy or surgery because of age, anatomy, or comorbidities,” Rogers explained. “They were left with the stark choice of doing nothing or palliative care. Electrosurgery opened the door to making many of these patients eligible for transcatheter treatment.”
The techniques, including transcaval access, BASILICA, LAMPOON, and SESAME, all use targeted electrosurgery to solve anatomical barriers that would otherwise disqualify patients from transcatheter aortic or mitral valve replacement. Each uses a modified surgical electrocautery wire to cut native valve leaflets to shave off excess cardiac tissue or bore an access between the venous and arterial vessels to enable unobstructed aortic valve access.
• Transcaval: This creates a temporary, controlled channel from the vena cava into the aorta to enable safe delivery of a transcatheter aortic valve replacement (TAVR) device in patients without suitable arterial access.
• BASILICA: This technique splits aortic valve leaflets to prevent coronary artery obstruction when a TAVR valve is placed. This is a severe complication with a 50% mortality risk if it occurs.
• LAMPOON: This method modifies the mitral valve leaflets to prevent obstruction of the left ventricular outflow tract (LVOT) during transcatheter mitral valve replacement (TMVR).
• SESAME: This is a newer procedure that uses electrosurgery to thin or splay the thickened septum in patients with hypertrophic cardiomyopathy (HCM), or in those at risk of LVOT obstruction during TMVR.
“These are enabling technologies,” Rogers said. “Every BASILICA patient is someone who likely would have been denied TAVR or forced into very high-risk surgery. With electrosurgery, we can prevent catastrophic complications and make transcatheter therapy possible.”
Although initially pioneered by a small group of specialists, the techniques are spreading rapidly through training workshops, registries, and even social media. Rogers noted that many operators worldwide have adopted BASILICA after watching recorded cases online or reading published reports.
Tracking the exact number of procedures remains difficult, but Rogers estimates the techniques have already benefited “thousands” of patients.
“We know there have been thousands of transcaval and BASILICA procedures, and LAMPOON is approaching a thousand cases worldwide,” he said.
The CRT 2025 Electrosurgery Summit marked the first time the program was opened to the wider interventional cardiology community. Sessions ranged from basic training on how to set up an electrosurgical program to advanced discussions on data, registries, and the pathway toward regulatory approval of on-label devices.
Looking ahead, Rogers said the focus will be on broader adoption, regulatory recognition, and the development of dedicated devices.
“The perception is that these procedures are complex, but they’re teachable and reproducible,” he said. “Electrosurgery has already transformed care for thousands, and it has the potential to help thousands more.”
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]