Hotwiring the Heart: Emory's Electrifying Breakthrough

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.