Hotwiring the Heart: Emory's Electrifying Breakthrough

How Emory Doctors Developed a New Electricity-Based Technique To Help a ‘Hopeless’ Patient

Elberta's cardiologist delivered the news compassionately but directly. There was nothing else he could do for her. Elberta had undergone a triple bypass in 2008 following a heart attack, but now, two of the four main valves in her heart were failing. She needed another open-heart surgery, but she was no longer a candidate due to her age.

That’s how Elberta found her way from Orange Park, Florida, to the offices of Adam Greenbaum, MD, and Vasilis Babaliaros, MD, at Emory University Hospital Midtown. Both Drs. Greenbaum and Babaliaros are cardiovascular specialists at Emory Heart & Vascular and leaders in structural heart disease care. Dr. Greenbaum immediately recognized Elberta as a good candidate for TAVR, a procedure pioneered at Emory. He hoped the new valve would give her the relief she needed.

Unfortunately, the TAVR procedure didn’t address all of Elberta’s conditions. She still suffered from the deterioration of the mitral valve and had hypertrophic cardiomyopathy, a condition that, over time, can keep the heart from taking in or pumping out enough blood during a heartbeat for a person’s body. Together, these conditions greatly reduced the blood flow from Elberta’s heart, and the enlarged muscle also blocked the space needed for a new mitral valve. 

The SESAME Procedure 

Unable to pursue open-heart surgery, Dr. Greenbaum attempted an alternative: using alcohol via catheter to shrink the heart muscle to make room for a mitral valve replacement. Unfortunately, he couldn't complete it due to Elberta’s poor vessel condition. With traditional options exhausted, Dr. Greenbaum faced limited choices for his patient.

Drs. Greenbaum and Babaliaros had been thinking about a new approach in collaboration with Robert Lederman, MD, and his team at the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH). They had been testing a procedure called Septal Scoring Along the Midline Endocardium (SESAME), which involves using an electrified wire to create space within the heart muscle without the need for open-chest surgery.

Dr. Greenbaum explained the SESAME procedure to Elberta, and explained that it was currently being tested on pigs. He asked her to give them five or six weeks to see how the pigs that underwent the procedure fared.

“When Elberta walked back in my office about a month later, her first words were, ‘How did the pigs do?’,” says Greenbaum. “I said they did just fine. And she said, ‘Then let’s go for it.’”

So, Elberta and Dr. Greenbaum decided to give the experimental procedure a chance.

In January 2021, Greenbaum and Babaliaros performed the first-ever procedure of Septal Scoring Along the Midline Endocardium (SESAME) on Elberta. This meant they had successfully created the necessary space for Elberta to have a mitral valve replacement several months later.

Today, Elberta feels good. So good, in fact, that she resumed hiking until she had to take a short break when she twisted her ankle. “Once your older patients start getting orthopedic injuries because they’ve become so active, you know you’ve hit on something good,” says Babaliaros, founder and co-director of the Structural Heart & Valve Program at Emory Heart & Vascular.

Research-Based Options Make a Difference

Elberta is just one of the latest in a long line of patients who have been referred to Emory when they have run out of options at other health centers. They come as a last resort to try novel options developed through a one-of-a-kind, decade-old collaboration between the Emory Heart & Vascular physicians and the NIH.

“We are able to offer these patients literally what no one else can,” said Kendra Grubb, MD, cardiothoracic surgeon and surgical director in Emory Heart & Vascular's Structural Heart & Valve Program. “Dr. Babaliaros and Dr. Greenbaum are pushing ahead in novel therapies that nobody else is even thinking of. All of this stems from their years of experience in a field they basically invented — transcatheter electrosurgery — with the help of their unique relationship with the NIH.”

For patients like Elberta, that means hope where there once was none.

“Mom is a totally new person,” says Pyle. “I have not seen her feeling this well since before her open-heart surgery. She’s out enjoying life again — walking and hiking nearly every day. I’ve got my mom back, and I couldn’t be happier.”

This story was first published at news.emory.edu.

World-Class Heart Care

About Emory Heart & Vascular

When it comes to the heart, expertise matters most. Emory Heart & Vascular has a national reputation for treating complicated heart conditions using the most advanced treatment options and therapies – and our heart specialists have pioneered many procedures now practiced widely in Georgia.

Our specialists are known for developing innovative techniques to diagnose and treat your heart problem without open surgery, revolutionizing the field of interventional cardiology. And our team is consistently recognized as one of the top heart health centers in the nation.

For people with heart failure, we are a national leader in areas such as hypertrophic cardiomyopathy and congenital heart disease. At the same time, we work hard to give people the information and tools they need to prevent heart disease before it starts. And all this happens close to you — we have more than 23 Heart & Vascular clinics across North Georgia.