VIDEO: Transcatheter myectomy to prevent LVOT obstruction in mitral valve replacement
Adam Greenbaum, MD, co-director of the structural heart and valve center, Emory, explains the use of transcatheter electrocautery to prevent left ventricular outflow tract (LVOT) obstruction using a new procedure called Septal Scoring Along the Midline Endocardium (SESAME).[1] The transcatheter procedure mimics surgical myotomy. He spoke on at the 2022 Transcatheter Valve Therapeutics (TVT) Structural Heart Summit.
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).
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Reference:
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: dfornell@innovatehealthcare.com