July 22, 2025
Mayo Clinic interventional cardiologists developed a new percutaneous technique to remove papillary fibroelastomas (PFEs). A clinical case series of their early experiences removing PFEs using mechanical aspiration techniques was published in JACC: Case Reports. The research adds to the growing field of transcatheter removal of intracardiac masses.
Surgical removal has been the conventional treatment for PFEs. The novel catheter-based technique offers a minimally invasive option as an alternative for high-risk patients who are not candidates for surgery.
"This is a unique procedure at Mayo Clinic because the technique was invented and first performed here, drawing upon the institution's world-class expertise in interventional and multimodality imaging, structural heart interventions, and cardio-oncology," says Abdallah El Sabbagh, M.D., an interventional cardiologist at Mayo Clinic in Jacksonville, Florida, and senior author of the study. "Successful execution of this procedure requires advanced expertise in structural interventions, real-time interventional imaging, and integrated care across cardiology, imaging and cardio-oncology — capabilities that uniquely position Mayo Clinic to lead in this space."
Urgent innovation
Papillary fibroelastomas are the most common noncancerous primary cardiac tumors. "Our series shows the successful technique we developed to remove these PFEs with catheters by aspirating and snaring the stalk," says Dr. El Sabbagh. "This approach is currently being used in clinical practice. It's considered off-label, but it enables the effective removal of PFEs in patients who would otherwise have no viable treatment options."
The study featured five cases. The patients ranged from ages 64 to 85, and all were considered too high risk for surgery. There were four female patients and one male patient.
The development arose from a growing clinical need to address PFEs in patients considered too high risk for open-heart surgery. "The field urgently needed this innovation because no percutaneous alternative existed for these patients. With PFEs, particularly those located on the left side of the heart, there is a significant risk of embolization — including stroke — due to their mobility and location," says Dr. El Sabbagh.
Capturing a mass
The technique involves a novel transcatheter approach that enables safe percutaneous removal of PFEs. "It begins by delicately using aspiration catheters to stabilize and immobilize the mobile tumor. Once the lesion is secured, a snare is precisely positioned around the stalk of the mass. This maneuver requires careful navigation to avoid injury to adjacent cardiac structures, particularly the valve leaflets," says Dr. El Sabbagh. "With the snare in place and tightened, radiofrequency energy is applied to the stalk while simultaneously ramping up aspiration, allowing for controlled transection and capture of the tumor."
Through multidisciplinary collaboration between cardiology, cardiothoracic surgery and pathology, Mayo Clinic continues to lead in PFE research and innovation. "We have significant experience with this particular mass," says Dr. El Sabbagh. "Mayo Clinic has a long-standing legacy in advancing the understanding of PFEs having produced some of the earliest and most comprehensive studies on this cardiac tumor. Its contributions span several decades and have helped define the clinical profile, diagnostic features and surgical outcomes associated with PFEs."
Next steps
The first goal will be creating a registry to systematically collect outcomes and refine patient selection. Then, it will be important to drive innovation to develop devices specifically engineered for transcatheter tumor removal. "The current approach repurposes tools designed for other applications, requiring a high level of improvisation," says Dr. El Sabbagh. "Purpose-built devices that integrate stabilization, snaring and energy delivery in a single platform could enhance procedural safety, efficiency and reproducibility."
Mayo Clinic is well positioned to lead this next phase, with expertise in both clinical innovation and medical device development. "Collaboration between interventional cardiologists, imaging specialists and bioengineers will be essential," says Dr. El Sabbagh. "Mayo Clinic can help design tools tailored to the unique challenges of intracardiac tumor resection and usher in a new era of minimally invasive therapy for benign cardiac tumors."
For more information
Seby R, et al. Percutaneous removal of cardiac papillary fibroelastomas. JACC: Case Reports. 2024;29:24.
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