VIDEO: Transcatheter myectomy to prevent LVOT obstruction in mitral valve replacement

This is the fourth procedure Greenbaum helped develop along with colleagues at the National Institutes of Health (NIH) that uses electrosurgery cutting technology modified for transcatheter heart procedures. These are all designed to expand the number of eligible patients for transcatheter valve replacement (TAVR) and transcatheter mitral valve replacement (TMVR)

These procedures include transcaval access between the aorta and venacava in patients whose lower aortic and femoral anatomy otherwise would excluded them from the transfemoral access approach. The other procedures are LAMPOON and BASILICA, which uses an electrified wire to slice one of the valve leaflets to enable access to the coronaries in TAVR and to reduce LVOT obstruction in TMVR.

SESAME is the most recent advance, using electrosurgery wires to perform a transcatheter myectomy. 

"We traverse the heart muscle at about a depth of half to two-thirds the thickness of the septum," Greenbaum explained. "We use electricity with transcatheter electrosurgery using a 0.014 wire, we are able to make a clean slice. Over time, this splays open and on CT looks very similar to a surgical myectomy."  

He said the procedure is all pre-planned by computed tomography (CT) because the operator needs to be very careful where to enter the septum to avoid any conduction systems and to ensure the cuts are being made where they are needed. During the procedure, bi-plane fluoroscopy is used to premising guide the wires, along with cardiac ultrasound, either transesophageal echo (TEE), transthoracic echo or intra-cardiac echo (ICE).

Related TEER and Mitral Valve Content:

VIDEO: Transcatheter tricuspid devices likely to gain FDA clearance before new mitral advances —  Azeem Latib, MD

New risk score predicts mortality after TEER

VIDEO: Advances in transcatheter tricuspid and mitral valve technology — Interview with Anita Asgar, MD

Both younger and elderly heart failure patients benefit from TEER

VIDEO: MitraClip vs. surgical mitral valve replacement — Interview with Joanna Chikwe, MD

Cutting edge findings shine new light on mitral valve surgery after failed TEER

New risk calculator detects TEER patients who may need to be readmitted for HF

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Links to all the late-breaking structural heart studies at TVT 2022

VIDEO: How to build a structural heart program — Interview with Charles Davidson, MD

Find more structural heart content and video



1. Jaffar M. Khan, Christopher G. Bruce, Adam B. Greenbaum,, et al. Transcatheter Myotomy to Relieve Left Ventricular Outflow Tract Obstruction: The Septal Scoring Along the Midline Endocardium Procedure in Animals. Circulation: Cardiovascular Interventions. 2022;15. Originally published 5 April, 2022.

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