TY - JOUR
T1 - Transcatheter Electrosurgery
T2 - JACC State-of-the-Art Review
AU - Khan, Jaffar M.
AU - Rogers, Toby
AU - Greenbaum, Adam B.
AU - Babaliaros, Vasilis C.
AU - Yildirim, Dursun Korel
AU - Bruce, Christopher G.
AU - Herzka, Daniel A.
AU - Schenke, William H.
AU - Ratnayaka, Kanishka
AU - Lederman, Robert J.
N1 - Funding Information:
This work was supported by the Division of Intramural Research, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH) grants Z01-HL006040 and Z01-HL006041 (to Dr. Lederman). The NHLBI has a collaborative research and development agreement with Edwards Lifesciences on transcatheter modification of the mitral valve (Dr. Lederman is the principal investigator). Drs. Khan and Rogers have been consultants/proctors for Edwards Lifesciences and Medtronic; and are coinventors with Dr. Lederman on patents, assigned to NIH, on catheter devices to lacerate valve leaflets. Dr. Greenbaum has been a proctor for Edwards Lifesciences, Medtronic, and Abbott Vascular; is a consultant for and holds equity in 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. Dr. Babaliaros has been a consultant for Edwards Lifesciences, Transmural Systems, and Abbott Vascular; holds equity in 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. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
This work was supported by the Division of Intramural Research, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH) grants Z01-HL006040 and Z01-HL006041 (to Dr. Lederman). The NHLBI has a collaborative research and development agreement with Edwards Lifesciences on transcatheter modification of the mitral valve (Dr. Lederman is the principal investigator). Drs. Khan and Rogers have been consultants/proctors for Edwards Lifesciences and Medtronic; and are coinventors with Dr. Lederman on patents, assigned to NIH, on catheter devices to lacerate valve leaflets. Dr. Greenbaum has been a proctor for Edwards Lifesciences, Medtronic, and Abbott Vascular; is a consultant for and holds equity in 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. Dr. Babaliaros has been a consultant for Edwards Lifesciences, Transmural Systems, and Abbott Vascular; holds equity in 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. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2020
PY - 2020/3/31
Y1 - 2020/3/31
N2 - Transcatheter electrosurgery refers to a family of procedures using radiofrequency energy to vaporize and traverse or lacerate tissue despite flowing blood. The authors review theory, simulations, and benchtop demonstrations of how guidewires, insulation, adjunctive catheters, and dielectric medium interact. For tissue traversal, all but the tip of traversing guidewires is insulated to concentrate current. For leaflet laceration, the “Flying V” configuration concentrates current at the inner lacerating surface of a kinked guidewire. Flooding the field with non-ionic dextrose eliminates alternative current paths. Clinical applications include traversing occlusions (pulmonary atresia, arterial and venous occlusion, and iatrogenic graft occlusion), traversing tissue planes (atrial and ventricular septal puncture, radiofrequency valve repair, transcaval access, Potts and Glenn shunts), and leaflet laceration (BASILICA, LAMPOON, ELASTA-Clip, and others). Tips are provided for optimizing these techniques. Transcatheter electrosurgery already enables a range of novel therapeutic procedures for structural heart disease, and represents a promising advance toward transcatheter surgery.
AB - Transcatheter electrosurgery refers to a family of procedures using radiofrequency energy to vaporize and traverse or lacerate tissue despite flowing blood. The authors review theory, simulations, and benchtop demonstrations of how guidewires, insulation, adjunctive catheters, and dielectric medium interact. For tissue traversal, all but the tip of traversing guidewires is insulated to concentrate current. For leaflet laceration, the “Flying V” configuration concentrates current at the inner lacerating surface of a kinked guidewire. Flooding the field with non-ionic dextrose eliminates alternative current paths. Clinical applications include traversing occlusions (pulmonary atresia, arterial and venous occlusion, and iatrogenic graft occlusion), traversing tissue planes (atrial and ventricular septal puncture, radiofrequency valve repair, transcaval access, Potts and Glenn shunts), and leaflet laceration (BASILICA, LAMPOON, ELASTA-Clip, and others). Tips are provided for optimizing these techniques. Transcatheter electrosurgery already enables a range of novel therapeutic procedures for structural heart disease, and represents a promising advance toward transcatheter surgery.
KW - BASILICA
KW - ELASTA-Clip
KW - LAMPOON
KW - transcatheter electrosurgery
KW - transcaval
UR - http://www.scopus.com/inward/record.url?scp=85082522419&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85082522419&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2020.01.035
DO - 10.1016/j.jacc.2020.01.035
M3 - Review article
C2 - 32216915
AN - SCOPUS:85082522419
SN - 0735-1097
VL - 75
SP - 1455
EP - 1470
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -