Key result
Antegrade LAMPOON and Alfieri stitch laceration on VA-ECMO enable successful valve-in-ring TMVR without outflow obstruction.
Why the study?
Transcatheter mitral valve replacement in failed surgical rings with an Alfieri stitch represents a therapeutic challenge.
Case Report (n=1)
No
This case demonstrates the feasibility of combining LAMPOON and ELASTIC techniques to facilitate high-risk valve-in-ring TMVR on VA-ECMO support in a patient with a failed surgical ring and Alfieri stitch.
Transcatheter mitral valve replacement (TMVR) in failed surgical rings with an Alfieri stich represents a therapeutic challenge. A 70-year-old man with prior robotic surgical mitral valve repair with an incomplete ring and an Alfieri stich presented with acute decompensated heart failure and was found to have severe mitral regurgitation and pulmonary hypertension. He was deemed not to be suitable for redo surgery. Preprocedural computed tomography demonstrated anterior mitral leaflet length of 29 mm, indicative of high-risk for dynamic left ventricular outflow tract obstruction. This case described the successful combination of antegrade laceration of the anterior mitral valve leaflet to prevent outflow obstruction and electrosurgical laceration of Alfieri stitch to facilitate valve-in-ring TMVR while on venoarterial extracorporeal membrane oxygenation support to prevent hemodynamic compromise during high-risk valve-in-ring TMVR.
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Asselin et al. (2026) conducted a case report in Severe mitral regurgitation and pulmonary hypertension (n=1). Valve-in-ring TMVR with antegrade LAMPOON and ELASTIC on VA-ECMO support was evaluated on Procedural success. Valve-in-ring TMVR was successfully performed using antegrade LAMPOON and electrosurgical laceration of an Alfieri stitch on VA-ECMO support to prevent outflow obstruction and hemodynamic compromise.
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