Transcatheter Myotomy to Treat Hypertrophic Cardiomyopathy and Enable Transcatheter Mitral Valve Replacement: First-in-Human Report of Septal Scoring Along the Midline Endocardium

• Type of Material: Article
• Authors: Adam Greenbaum, Emory University; Jaffar M Khan, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda; Christopher G Bruce, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda; George Hanzel, Emory University; Patrick Gleason, Emory University; Keshav Kohli, Georgia Tech and Emory University; Errol Inci, Emory University; Robert Guyton, Emory University; Gaetano Paone, Emory University; Toby Rogers, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda; Robert Lederman, Emory University; Vasilis Babaliaros, Emory University
• Language: English
• Date: 2022-06-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022, Wolters Kluwer Health
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCINTERVENTIONS.122.012106
• Title of Journal or Parent Work: CIRCULATION-CARDIOVASCULAR INTERVENTIONS
• Volume: 15
• Issue: 6
• Start Page: E012106
• End Page: E012106
• Grant/Funding Information: Supported by Emory Structural Heart and Valve program intramural funds, and by NIH Z01-HL006040.
• Keywords: Cardiovascular System & Cardiology; heart valve prosthesis implantation; OBSTRUCTION; hypertrophic; cardiac surgical procedures; Cardiac & Cardiovascular Systems; cardiomyopathy; ventricular outflow obstruction; ventricular remodeling; Life Sciences & Biomedicine; Science & Technology; myotomy; heart septum

Abstract

Transcatheter mitral valve replacement (TMVR) risks left ventricular outflow tract (LVOT) obstruction from permanent displacement of the anterior leaflet and/or the implant itself in cases of hypertrophied ventricles1,2. While LAMPOON mitigates the risk associated with displacement of the anterior mitral leaflet3, obstruction from the TMVR is often addressed with ventricular septal reduction. Ablation with either alcohol or radiofrequency risks geographic miss, inadequate debulking, and complete heart block. It also requires time-dependent myocardial necrosis, which delays therapeutic TMVR. We developed a novel transcatheter electrosurgical myotomy mimicking classic surgical myectomy to overcome these limitations4. Herein we report the first SESAME (Septal Scoring Along Midline Endocardium) procedure to treat hypertrophic cardiomyopathy and allow TMVR.