Electrosurgical septotomy across the full spectrum of aortic dissection
Gabriel Weiss, Hubert Trnka, Sebastian Tauber, Emely Manville, Zsuzsanna Arnold, Bernhard Winkler, Sandra Folkmann, Martin GrabenwögerAbstract
Objectives
Transcatheter electrosurgical septotomy divides the dissection membrane to reconstitute a single aortic lumen. Reported experience is largely confined to chronic post-dissection aneurysms. We assessed the technique across the full spectrum of descending aortic dissection, including stand-alone treatment of malperfusion.
Methods
Retrospective intention-to-treat analysis of 21 consecutive patients scheduled for septotomy between June 2022 and May 2026. The membrane was crossed by needle re-entry and divided with an electrified through-and-through guidewire at 40–60 W under fluoroscopy, without routine intravascular ultrasound or image fusion. A perfused-lumen index (perfused lumen divided by total aortic diameter) was measured before and after the procedure.
Results
Septotomy was performed in 20 of 21 patients (technical success 95% on an intention-to-treat basis). Indications were landing-zone preparation (57%), malperfusion (33%), preparation for open repair and true-lumen collapse. Malperfusion resolved in all 7 patients treated for that indication, and the perfused-lumen index rose from a median of 0.16 to 0.98 (18 patients, P < 0.001). There was no stroke, spinal cord ischaemia or retrograde type A dissection. Thirty-day, in-hospital and overall mortality were 10%, 14% and 19%, with one fatal delayed aortic rupture and no intraprocedural death. Three unplanned reinterventions occurred; median follow-up was 5.1 months.
Conclusions
Electrosurgical septotomy was feasible across the full spectrum of aortic dissection and, in selected patients, as stand-alone treatment for malperfusion, using standard electrosurgical equipment. Given the small heterogeneous cohort and short follow-up, these findings demonstrate feasibility rather than durability.