Application of Transcatheter Electrosurgery in Structural Heart Interventions: A Report of Three Different Techniques

Transcatheter electrosurgery is a novel technique to traverse or cut tissue, within blood-filled spaces, using alternating current directed by guidewires and catheters. We report the first series of transcatheter electrosurgery procedures in Asia including transcaval access for transcatheter aortic valve implantation, intentional aortic leaflet laceration to mitigate the risk of coronary occlusion in transcatheter aortic valve implantation and intentional laceration of anterior mitral valve leaflet to mitigate the risk of left ventricular outflow tract obstruction. These procedures are potentially valuable in Asian patients because of their smaller body build compared to Caucasians posing a higher risk of coronary or left ventricular outflow tract obstruction during transcatheter valve implantation. There is a need to adopt transcatheter electrosurgery in Asia to treat more surgically inoperable patients, including proper simulation training, bench training and clinical proctorship.