Novel Use of Radiofrequency Guidewire in Leaflet Modification: The BABICORN and ROBIN Procedures

Leaflet modification techniques are increasingly used in transcatheter valve interventions to prevent complications such as coronary artery obstruction and left ventricular outflow tract obstruction. We present 2 cases illustrating novel use of the PowerWire Pro guidewire (Baylis Medical Technologies) for successful leaflet traversal.

1) Determine optimal angle for leaflet traversal; 2) position the PowerWire Pro at the base of the target leaflet; 3) traverse the leaflet using the PowerWire and electrocautery; and 4) perforate the leaflet using serial balloon dilatations.

Higher tip load may lead to complications if perforation in suboptimal location; traversal of a calcified leaflet may be more difficult with a larger wire.

The use of the Baylis PowerWire Pro guidewire for leaflet modification is a novel technique that has potential advantages over the commonly used Asahi Astato wire, including fewer equipment exchanges, added support for catheter delivery, and increased push ability for easier leaflet traversal.