Open SESAME: Heart surgery without the surgery

2024

Challenge

In a common inherited heart disease called hypertrophic cardiomyopathy, the heart grows so muscular and thick that blood can't exit its chambers during pumping, almost as if a valve is blocked. NIH doctors created a surgical procedure, called myectomy, to slice a path through the blocked muscle to treat hypertrophic cardiomyopathy in the 1960s and 1970s, but the surgery is difficult for patients to endure and for doctors to perform. Other doctors have provided non-surgical treatments by injecting alcohol to cause controlled heart attacks, but these procedures are not always effective and often damage the heart’s electrical system.

Advance

IRP researchers and physicians led by Robert Lederman, M.D., and a team of doctors from Emory University School of Medicine worked together to create a new treatment called SESAME ( SEptal Scoring Along Midline Endocardium) to mimic the classic myectomy surgery, but without the patient needing to undergo open heart surgery. SESAME uses electrified wires and catheters to burn a slice in the thick heart muscle to make room for normal blood flow, all without surgery and without needing to halt the patient’s heartbeat. 

Impact

SESAME offers a new way to treat hypertrophic cardiomyopathy without surgery. The procedure has been performed in over 100 patients so far, mainly at Emory University, and mainly in patients who are too sick to undergo conventional surgery. What’s more, SESAME introduces a new family of potential treatments to repair or change the muscle in the heart without stopping the heartbeat. These new treatments may be helpful for other forms of heart muscle disease, especially among patients who are not eligible for surgery.

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