A transcatheter electrosurgery guidewire system that can potentially be used in several different kinds of interventional cardiology procedures won the Best Innovation Award at Cardiovascular Research Technologies (CRT) 2023. Jaffar M. Khan, MD, PhD, of St. Francis Hospital and Heart Center, Roslyn, New York, gave the winning presentation of the TELLTALE Electrosurgery Guidewire System during the contest in Washington, DC. He described transcatheter electrosurgery tissue modification as already demonstrating safety and efficacy in multiple clinical trials and registries. TELLTALE is the first dedicated system for transcatheter electrosurgery tissue laceration. At its core, Khan said, is an 0.014-inch electrosurgery guidewire that is 310 cm long and insulated throughout nearly all of its length with parylene coating, leaving 1 mm exposed at the tip for tissue traversal and a smaller portion exposed at the back end to dock into an electrosurgery generator. “In the center of this guidewire is a gold marker which you can straddle the tissue that you want to lacerate,” he said. “In addition, there are dedicated guide shapes. At the moment, we are using guides that direct you into the coronary artery. We now have dedicated guides that guide you onto the target leaflet. These guides also have appropriate electrical insulative properties to direct energy solely onto the target tissue.” The device also has a kinker denuder into which the wire can be placed, “and this reliably and reproducibly creates what we call the Flying V, which is selective inner surface denudation of that guidewire … which is crucial to charge concentration.” An investigational device exemption pivotal study, sponsored by the National Heart, Lung, and Blood Institute, has begun enrolling. It is planned to enroll 75 patients with bioprosthetic or native aortic stenosis at 10 sites in the U.S. He said the device has several patents. Khan performed the first-in-human procedure within the last week with this device. He showed the case, in which he positioned the guide catheter “pretty easily into the target cusp, which is the left leaflet.” Then he introduced the guidewire “very simply and with a foot pedal, electrified through the base of that leaflet.” He confirmed the position in front of the left coronary artery with echocardiography. He then quickly kinked and denuded the wire in the kinker denuder, introduced the kink into the body and tightened the catheter all around. He said the device’s dedicated clasp system makes it “well and secure.” Khan then lacerated the leaflet with “zero mechanical force, it’s all electrosurgical.” The fluoroscopy showed “a nice laceration of the leaflet,” with stable hemodynamics and “a nice split right in front of the left main coronary artery” shown on echo. The valve was deployed, there was “brisk flow through the coronary arteries,” and the patient was discharged in 2 days, he said. He said TELLTALE “takes the guesswork out of these electrosurgical procedures.” He said that if this indication were to be approved, it would “promote dissemination and proctorship” – something that is not possible at the moment. He concluded that investigation of the device for use as a tool in different kinds of electrosurgical procedures is warranted. Before naming the top three winners of the competition, which included 14 entries that were presented Monday, Steven R. Bailey, MD, of LSU Health Shreveport, co-chair of the contest praised everyone who submitted entries. “I was impressed that the quality of presentations routinely was ranked very high,” he said, later adding, “I think that we really have a superb group of presenters. We’re excited that they were chosen.” The other two winners recognized at the competition were: Second place: Chris G. Bruce, MBChB, of the National Heart, Lung, and Blood Institute, for “MIRTH (Myocardial Intramural Remodeling by Transvenous Tether) Ventriculoplasty,” and Third place: Steven F. Bolling, MD, of the University of Michigan Hospital, for “Automated Vascular Closure for Large-Bore Therapies (xDot Medical).” Photo Caption: Jaffar M. Khan, MD, PhD, joyfully leaves his seat after he is announced as the winner of the CRT 2023 Best Innovation Award. Photo Credit: Shmulik Almany for CRTonline.org