Novel Use of Radiofrequency Guidewire in Leaflet Modification

OBJECTIVE: 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. KEY STEPS: 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. POTENTIAL PITFALLS: 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. TAKE-HOME MESSAGE: 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.