Transcatheter Electrosurgery: JACC State-of-the-Art Review

Jaffar M. Khan, Toby Rogers, Adam B. Greenbaum, Vasilis C. Babaliaros, Dursun Korel Yildirim, Christopher G. Bruce, Daniel A. Herzka, William H. Schenke, Kanishka Ratnayaka, Robert J. Lederman

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1455-1470
Number of pages16
JournalJournal of the American College of Cardiology
Volume75
Issue number12
DOIs
StatePublished - Mar 31 2020

Keywords

  • BASILICA
  • ELASTA-Clip
  • LAMPOON
  • transcatheter electrosurgery
  • transcaval

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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