SESAME technique: septal scoring along the midline endocardium

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Interventricular septal hypertrophy management is critical, particularly for transcatheter mitral valve replacement (TMVR) and obstructive hypertrophic cardiomyopathy (oHCM).
• Existing treatments face challenges, necessitating novel approaches for septal reduction therapy.

Purpose of the Study:

• To evaluate the reproducibility and efficacy of the septal scoring along the midline endocardium (SESAME) procedure.
• To assess SESAME's potential as a transcatheter alternative to surgical myotomy for septal reduction.

Main Methods:

• A retrospective review of 54 patients undergoing the SESAME procedure at a single center from January 2022 to September 2024.
• Patients included those undergoing SESAME prior to TMVR, for oHCM, or for a subaortic membrane.

Main Results:

• 100% technical success was achieved with SESAME.
• Significant reductions in left ventricular outflow tract (LVOT) gradients were observed in oHCM patients (resting: 59 to 10 mmHg; provoked: 121 to 34 mmHg).
• In pre-TMVR patients, substantial gains in neo-LVOT and skirt neo-LVOT areas were noted, with a decrease in procedural complications over time.

Conclusions:

• SESAME is a feasible and effective transcatheter septal reduction therapy for high-risk patients.
• The procedure is beneficial for patients needing septal reduction prior to TMVR, those with oHCM, or subaortic membranes.