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Review
. 2022 Jul;11(3):257-266.
doi: 10.1016/j.iccl.2022.01.004.

Use of Electrosurgery in Interventional Cardiology

Jaffar M Khan  1 , Toby Rogers  2 , Adam B Greenbaum  3 , Vasilis C Babaliaros  4 , Christopher G Bruce  5 , Robert J Lederman  6
Affiliations
Review

Use of Electrosurgery in Interventional Cardiology

Jaffar M Khan et al. Interv Cardiol Clin. 2022 Jul.

Abstract

Transcatheter electrosurgery is a versatile tool that can be used to cut cardiac tissue without the need for a sternotomy, cardiopulmonary bypass, and cardioplegia. With adequate imaging and suitable anatomy, any cardiac tissue can be cut. Thus, transcatheter electrosurgery can provide bespoke therapies for complex patients who often have no other good treatment options. In this review, we will discuss the common applications for electrosurgical tissue traversal and laceration, including transcaval access, BASILICA, LAMPOON, and ELASTA-Clip, summarizing the evidence and the key technical steps for each.

Keywords: Basilica; Lampoon; TAVR; TMVR.

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Conflict of interest statement

DISCLOSURE

(J.M.Khan), (T.Rogers), and (R.J.Lederman) are co-inventors on patents, assigned to NIH, on catheter devices to lacerate valve leaflets.(A.B.Greenbaum) is a proctor for Edwards Lifesciences, Medtronic, and Abbott Vascular. He has equity in Transmural Systems. (V.C.Babaliaros) is a consultant for Edwards Lifesciences, Abbott Vascular and Transmural Systems, and his employer has research contracts for clinical investigation of transcatheter aortic and mitral devices from Edwards Lifesciences, Abbott Vascular, Medtronic, St Jude Medical, and Boston Scientific. (T.Rogers) is a consultant/proctor for Edwards Lifesciences and Medtronic. He has equity in Transmural Systems. (R.J.Lederman) is the principal investigator on a Cooperative Research and Development Agreement between NIH and Edwards Lifesciences on transcatheter modification of the mitral valve. No other author has a financial conflict of interest related to this research.

Figures

Fig. 1.
Fig. 1.
Transcaval access. (A) An electrified guidewire traverses from a guide in the IVC to a snare in the infra-renal aorta. (B) Sequential microcatheters are advanced into the aorta during snare countertraction. (C) The large sheath is introduced. (D) The aortotomy is closed with a nitinol mesh device.
Fig. 2.
Fig. 2.
Algorithm for predicting coronary obstruction.
Fig. 3.
Fig. 3.
BASILICA procedure steps (A) An electrified guidewire traverses from a guide in the aorta through the target aortic valve leaflet into a snare in the LVOT. (B and C) The flying V is electrified, lacerating the leaflet. (D) The leaflet splays after TAVR, maintaining coronary perfusion.
Fig. 4.
Fig. 4.
Catheter escalation strategy for BASILICA.
Fig. 5.
Fig. 5.
Tip to Base LAMPOON (A). A veno-arterial rail is created through a transseptal deflectable sheath. (B). The flying V is positioned at the tip of the anterior leaflet of the bioprosthetic mitral valve. (C). The leaflet is lacerated and the flying V is stopped from further progression by the valve sewing ring. (D). Successful mitral valve-in-valve TMVR.
Fig. 6.
Fig. 6.
ELASTA-Clip. (A). The flying V (black arrow) is positioned on the anterior edge of 2 MitraClip devices (white arrows). (B and C) The MitraClip devices are secure on the posterior ventricular wall and Tendyne TMVR valve is fully expanded.
See this image and copyright information in PMC

References

    1. Khan JM, Rogers T, Greenbaum AB, et al. Transcatheter electrosurgery: JACC State-of-the-art review. J Am Coll Cardiol 2020;75(12):1455–70. - PMC - PubMed
    1. Rosenthal E, Qureshi SA, Chan KC, et al. Radiofrequency-assisted balloon dilatation in patients with pulmonary valve atresia and an intact ventricular septum. Br Heart J 1993;69(4):347–51. - PMC - PubMed
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    1. Khan JM, Rogers T, Eng MH, et al. Guidewire electrosurgery-assisted trans-septal puncture, 2017. Catheter Cardiovasc Interv 2018;91(6):1164–70. - PMC - PubMed
    1. Hsu JC, Badhwar N, Gerstenfeld EP, et al. Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study). J Am Heart Assoc 2013;2(5):e000428. - PMC - PubMed

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