Efficacy of Cautery-Assisted Transeptal Puncture in RHD

Dr. Akshay Bafna, Dr. Hardik More

Abstract: Introduction: Rheumatic heart disease (RHD) remains a major cause of morbidity and mortality in developing regions, primarily affecting the mitral and aortic valves due to progressive fibrosis and calcification. Conventional transseptal puncture (TSP) techniques face challenges in RHD patients due to thickened and fibrotic interatrial septa, increasing procedural risks. Cautery-Assisted TSP (CA-TSP) has emerged as an effective alternative, reducing force requirements, minimizing complications, and improving procedural success. CA-TSP shortens procedural time, enhances safety, and lowers radiation exposure. While promising, specialized training and equipment are needed for broader implementation. Further research is essential to validate its long-term efficacy and accessibility. Methods: This retrospective study evaluated the use of radiofrequency (RF) current with a surgical electrocautery needle for atrial Transseptal Puncture (TSP) in patients undergoing interventional procedures for rheumatic heart disease (RHD). Data were collected from a single center between January 2024 and January 2025, involving 22 adult patients. Inclusion criteria covered all RHD patients undergoing RF-assisted TSP, while exclusions applied to those with contraindications or incomplete records. The procedure used RF energy (50 W) to cross the atrial septum, assessing functional improvement (NYHA class), septal normalization, and laboratory markers (BNP, WBC, hemoglobin) to compare Conventional and Cautery-Assisted TSP outcomes. Results: The findings indicate that both Conventional TSP and Cautery-Assisted TSP resulted in significant improvements in NYHA class, with p-values of 0.042 and 0.0411 for within-group comparisons, respectively. However, the change in NYHA class improvement between the two groups was not statistically significant (p = 0.069). Additionally, Cautery-Assisted TSP showed a higher success rate (100%) compared to Conventional TSP (80%) with a p-value of 0.047. Procedure duration, post-procedure complications, and recovery time were all significantly improved in the Cautery-Assisted TSP group, with p-values of 0.0425, 0.047, and 0.0466, respectively. Regarding laboratory parameters, BNP levels increased significantly more in the Conventional TSP group (p = 0.021), while WBC and hemoglobin levels showed notable differences between the groups (p = 0.035 and p = 0.0432). These results suggest that Cautery-Assisted TSP may lead to better clinical outcomes with fewer complications and milder post-procedural effects. Conclusion: The study has concluded that Cautery-Assisted TSP was found to have significant advantages over Conventional TSP in terms of procedure success, duration, post-procedure complications, and recovery time.

Keywords: rheumatic heart disease, transeptal puncture, BNP, cautery assisted puncture