What does this research mean for the field?

Simultaneous transcatheter aortic and mitral valve-in-valve implantation restored valve function with mean gradients of 3 mmHg (mitral) and 10 mmHg (aortic). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the safety and efficacy of simultaneous transcatheter valve-in-valve implantation in a patient with severe bioprosthetic stenosis.

February 13, 2026Open Access

Simultaneous Transcatheter Aortic and Mitral Valve-in-Valve Implantation With Edwards Sapien 3 Valves Using LAMPOON: A Case Report

Key Result

Simultaneous transcatheter aortic and mitral valve-in-valve implantation with Edwards Sapien 3 valves using LAMPOON prevented LVOT obstruction and restored valve function (mitral mean gradient 3 mmHg,

Key Points

To evaluate the safety and efficacy of simultaneous transcatheter valve-in-valve implantation in a patient with severe bioprosthetic stenosis.
Performed transfemoral transcatheter aortic and mitral valve-in-valve implantation.
Employed the LAMPOON technique to prevent left ventricular outflow tract obstruction.
Used Edwards Sapien 3 valves for both aortic and mitral replacement.
Post-procedure echocardiography showed restored valve function.
Mitral mean gradient decreased to 3 mmHg.
Aortic mean gradient decreased to 10 mmHg.
Recovery was uncomplicated, indicating procedural safety.

Structured PICO

Is simultaneous transcatheter aortic and mitral valve-in-valve implantation with the LAMPOON technique feasible and effective in a high-risk patient with dual bioprosthetic valve degeneration?

Population

1 76-year-old female with rheumatic heart disease presenting with progressive dyspnea 12 years after dual surgical bioprosthetic valve replacement (mitral: 25 mm; aortic: 21 mm), with severe stenosis of both prostheses and high surgical risk.

Intervention

Simultaneous transfemoral transcatheter aortic and mitral valve-in-valve implantation using Edwards Sapien 3 valves, combined with the LAMPOON (Laceration of the Anterior Mitral leaflet to Prevent left ventricular Outflow Obstruction) technique.

Outcome

Post-procedural recovery and restored valve function (mitral and aortic mean gradients).surrogate

Simultaneous transcatheter aortic and mitral valve-in-valve implantation using the LAMPOON technique is a feasible strategy for treating complex dual bioprosthetic degeneration in patients at high surgical risk.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract A 76-year-old female with rheumatic heart disease presented with progressive dyspnea 12 years after dual surgical bioprosthetic valve replacement (mitral: 25 mm; aortic: 21 mm). Diagnostic imaging revealed severe stenosis of both prostheses, with a mitral valve area of 0.8 cm 2 and an aortic valve area of 1.06 cm 2 , complicated by a risk of left ventricular outflow tract obstruction (neo-left ventricular outflow tract obstruction area: 110 mm 2 ). Given the high surgical risk, simultaneous transfemoral transcatheter aortic and mitral valve-in-valve implantation was performed using Edwards Sapien 3 valves. The Laceration of the Anterior Mitral leaflet to Prevent left ventricular Outflow Obstruction (LAMPOON) technique was employed to prophylactically divide the anterior bioprosthetic leaflet, preventing left ventricular outflow tract obstruction. Post-procedural recovery was uncomplicated, and echocardiography demonstrated restored valve function; the mitral mean gradient was 3 mmHg and the aortic mean gradient was 10 mmHg. This case demonstrates the feasibility of dual valve-in-valve therapy for patients with complex bioprosthetic degeneration.