Search

Transcatheter intervention for cardiac valve disease is an attractive alternative to open heart surgery, avoiding a thoracotomy and cardiopulmonary bypass, and associated morbidity. A limitation of transcatheter intervention is the inability to cut tissue – the hallmark of surgery, and what makes it so versatile. During transcatheter valve implantation, native diseased valve tissue is displaced rather than resected. However, this displacement can occasionally cause fatal complications. In transcatheter mitral valve implantation, septal displacement of the anterior mitral valve leaflet can obstruct the left ventricular outflow tract. In transcatheter aortic valve implantation, displacement of the left or right coronary cusps may obstruct the flow to the coronary arteries. This thesis explores the use of radiofrequency energy delivered through guidewires directed by catheters to enable closed-chest beating-heart valve leaflet laceration using marketed devices. We call this technique transcatheter electrosurgery. Two entirely novel procedures are developed that use transcatheter electrosurgery techniques to cut valve tissue prior to transcatheter valve implantation: LAMPOON (Laceration of the Anterior Mitral leaflet to Prevent left ventricular Outflow ObstructioN); and BASILICA (Bioprosthetic and native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction). Benchtop experiments, pre-clinical procedure development in swine, first-in-human “compassionate use” experience, and early feasibility clinical trials are described for each procedure.