Key result
Anterior mitral leaflet modification techniques mitigate LVOTO risk during TMVR to expand patient eligibility.
Why the study?
Left ventricular outflow tract obstruction is a catastrophic complication and leading cause of candidate exclusion in transcatheter mitral valve replacement, prompting the emergence of percutaneous anterior mitral leaflet modification techniques to mitigate risk and expand treatment eligibility.
Do percutaneous anterior mitral leaflet modification techniques mitigate left ventricular outflow tract obstruction risk and expand treatment eligibility in patients undergoing transcatheter mitral valve replacement?
Do percutaneous anterior mitral leaflet modification techniques mitigate left ventricular outflow tract obstruction risk and expand treatment eligibility in patients undergoing transcatheter mitral valve replacement?
This review discusses pre-procedural CT risk stratification and percutaneous anterior leaflet modification techniques (such as LAMPOON, ELASTA, and BATMAN) to prevent catastrophic left ventricular outflow tract obstruction and expand patient eligibility for transcatheter mitral valve replacement.
Answers are grounded in this paper and cite their sources.
Supports leaflet modification in high-risk TMVR; leaves open need for prospective trials before routine adoption.
Left ventricular outflow tract obstruction (LVOTO) remains one of the most catastrophic complications of transcatheter mitral valve replacement (TMVR) interventions, including TMVR in native valve, valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification procedures. Its incidence varies widely across procedural types (0%-40%), with mortality rates approaching 36%, and represents a leading cause of patient ineligibility, excluding 4%-50% of candidates from TMVR. Accurate pre-procedural risk stratification relies on cardiac computed tomography, which enables annular sizing, virtual valve implantation, neo- and skirt neo-left ventricular outflow tract area quantification, and fluoroscopic projection planning. Key anatomic determinants of LVOTO include anterior mitral leaflet length, aortomitral angle, septal hypertrophy, left ventricular cavity size, and device-related factors. To mitigate LVOTO risk and expand treatment eligibility, in addition to septal modification, anterior mitral leaflet modification techniques have emerged, broadly categorized into electrosurgical laceration approaches-LAMPOON and ELASTA-and balloon-assisted translocation techniques for balloon-expandable valves-BATMAN, CLEVE, DETROIT, and ROBIN. Each strategy addresses distinct anatomic substrates and procedural scenarios, and their complementary profiles support individualized technique selection. This review aims to present an in-depth discussion of LVOTO in TMVR and anterior leaflet modification strategies.
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Guicciardi et al. (2026) conducted a review in Transcatheter mitral valve replacement (TMVR) at risk for left ventricular outflow tract obstruction (LVOTO). Percutaneous anterior mitral leaflet modification techniques (LAMPOON, ELASTA, BATMAN, CLEVE, DETROIT, ROBIN) was evaluated on Left ventricular outflow tract obstruction (LVOTO). Anterior mitral leaflet modification techniques mitigate LVOTO risk in TMVR, where LVOTO incidence ranges from 0%-40% with mortality rates approaching 36%.
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