Key result
Novel tip-to-base LAMPOON technique prevents LVOT obstruction during valve-in-valve TMVR in a single patient.
Why the study?
TMVR is a new approach for failed mitral bioprostheses with risk of LVOT obstruction, and current techniques to prevent obstruction have limitations.
Case Report (n=1)
Tip-to-base LAMPOON represents a novel and potentially simpler technique to prevent LVOT obstruction during transcatheter mitral valve replacement in high-risk patients.
May support preemptive alcohol septal ablation to reduce LVOT obstruction risk in high-risk TMVR; hypothesis-generating and needs prospective validation.
Transcatheter mitral valve replacement (TMVR) is a new approach for treating failed bioprosthetic valves, annuloplasty repairs, and mitral annular calcification. Computed tomography is the key in procedure planning and guiding to identify patients at high risk of anatomic complications, in particular, for left ventricular outflow tract (LVOT) obstruction. There are several methods to reduce the risk of LVOT obstruction. A simple option is preemptive alcohol septal ablation, but this needs to be done prior to the TMVR procedure. Intentional laceration of the anterior mitral leaflet to prevent LVOT obstruction (LAMPOON), a transcatheter electrosurgical technique to split the anterior mitral valve leaflet immediately prior to TMVR, can be done anterograde or retrograde but requires leaflet traversal, which is technically challenging. In this article, we describe a case of valve-in-valve TMVR in a patient with high risk for LVOT obstruction and a novel simple technique-tip-to-base LAMPOON.
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Ben‐Dor et al. (2021) conducted a case report in Failing mitral bioprosthesis at high risk for LVOT obstruction (n=1). Valve-in-valve TMVR with tip-to-base LAMPOON was evaluated. A novel tip-to-base LAMPOON technique was described for preventing left ventricular outflow tract obstruction during valve-in-valve transcatheter mitral valve replacement in a single patient.