Author + information
- Received October 3, 2019
- Revision received January 16, 2020
- Accepted January 21, 2020
- Published online March 23, 2020.
- Jaffar M. Khan, BM BCha,b,
- Toby Rogers, BM BCh, PhDa,b,
- Adam B. Greenbaum, MDc,
- Vasilis C. Babaliaros, MDc,
- Dursun Korel Yildirim, MSa,
- Christopher G. Bruce, MB ChBa,
- Daniel A. Herzka, PhDa,
- William H. Schenke, BSa,
- Kanishka Ratnayaka, MDa,d and
- Robert J. Lederman, MDa,∗ (, )@TheBethesdaLabs
- aCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- bMedstar Washington Hospital Center, Washington, DC
- cStructural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
- dUCSD Rady Children’s Hospital, San Diego, California
- ↵∗Address for correspondence:
Dr. Robert J. Lederman, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, Maryland 20892-1538.
• Transcatheter electrosurgery uses continuous duty-cycle radiofrequency energy to vaporize and therefore traverse or lacerate tissue.
• Tissue traversal requires guidewire insulation and adjunctive insulating catheters to concentrate charge at the tip of traversing guidewires.
• The Flying V configuration of a kinked guidewire can cut valve leaflets by concentrating charge at the inner lacerating surface of the guidewire and by eliminating alternative current paths using non-ionic dextrose flush.
• Applications include transcaval access, BASILICA, LAMPOON, ELASTA-Clip, and many others.
• Transcatheter electrosurgery is a logical step toward transcatheter surgery
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.
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.
- Received October 3, 2019.
- Revision received January 16, 2020.
- Accepted January 21, 2020.
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