AUTHOR=Garg Pankaj , Lykins Amy , Alomari Mohammad , Reynolds Jordan P. , Johnson Elizabeth , Sareyyupoglu Basar 

TITLE=PlasmaBlade-assisted surgical septal myectomy: technique and our experience

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1345540

DOI=10.3389/fcvm.2024.1345540

ISSN=2297-055X

ABSTRACT=Pulsed Electron Avalanche Knife (PEAK) PlasmaBlade provides an atraumatic, scalpel-like cutting precision and electrocautery-like hemostasis. PlasmaBlade operates near body temperature, and its long, thin, and malleable tip can overcome the limitations of a surgical knife. This study aimed to evaluate our clinical experience and histopathological outcomes of septal myectomy using PlasmaBlade.Electronic medical records were reviewed for preoperative, operative, and follow-up data of the patients operated on for septal myectomy using PEAK PlasmaBlade in our institute between January 2019 and December 2022. Histopathology of the myectomy specimens was reviewed for the depth of muscle necrosis and compared with the left atrial appendage (LAA) specimen.Twenty-nine patients underwent septal myectomy using PEAK PlasmaBlade. There was no mortality. The mean age was 60.6±12.5years, and 58.6% were male. Peak LVOT gradients were 40.5±34.9mmHg at rest and 56.5±34.9mmHg after provocation. Concomitant procedures performed were LAA ligation in 20 (69.0%), aortic valve replacement in 5 (17.2%), and coronary artery bypass grafting in 3 (10.3%) patients. Postoperative complications were complete heart block in one (3.4%) and ventricular septal defect in two (6.9%) patients, respectively. Both the ventricular septal defects were identified intraoperatively and repaired.Histopathology of myectomy specimen demonstrated cautery artifact limited to <50µm depth compared to >1000µm with conventional electrocautery. At a mean follow-up of 8.4±10.3months, the mean LVOT gradient was 4.4±5.8mmHg at rest and 9.5±3.3mmHg after provocation. All patients were alive and in NYHA class I/II. No patient developed complications or required reintervention or reoperation.Adequate septal myectomy can be precisely and safely performed using PEAK PlasmaBlade with minimal collateral damage.