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 - 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 -