From the Research
The SESAME procedure, in the context of left ventricular outflow tract obstruction, involves a novel transcatheter myotomy technique called Septal Scoring Along the Midline Endocardium, which has shown feasibility in animal studies. This procedure aims to relieve left ventricular outflow tract obstruction by mechanically entering the basal interventricular septum and lacerating the myocardium using transcatheter electrosurgery, as described in the study by 1. The key steps in this procedure include using coronary guiding catheters and guidewires to navigate the septum, imparting a tip bend to the guidewire for intramyocardial navigation, and lacerating the myocardium to increase the left ventricular outflow tract area.
Key Considerations
- The SESAME procedure has been demonstrated in animal models, including naive pigs and pigs with induced left ventricular hypertrophy, showing an increase in left ventricular outflow tract area without significant complications in most cases, as reported by 1.
- The technique involves the use of available devices and has a safe surgical precedent, making it potentially translatable to human patients, as noted in the study by 1.
- However, the procedure requires careful consideration of septal thickness and the risk of ventricular septal defects, particularly in patients with thin septa, as highlighted by the complications observed in some animal subjects by 1.
Comparison with Other Evidence
While other studies, such as those on sesame allergy by 2, 3, 4, and 5, provide valuable information on the diagnosis and management of sesame allergy, they are not directly relevant to the SESAME procedure in the context of left ventricular outflow tract obstruction. The most recent and highest quality study on this topic is the one by 1, which provides the basis for the recommendation on the SESAME procedure.
Clinical Implications
The SESAME procedure offers a potential transcatheter solution for relieving left ventricular outflow tract obstruction, which could improve outcomes for patients with hypertrophic cardiomyopathy or those undergoing transcatheter mitral valve replacement, as suggested by the findings of 1. However, further clinical studies are necessary to fully evaluate its safety and efficacy in human patients.