Tip-to-Base LAMPOON for Transcatheter Mitral Valve Replacement With a Protected Mitral Annulus

• Type of Material: Article
• Authors: John C Lisko, Emory University; Vasilis Babaliaros, Emory University; Jaffar M Khan, NHLBI; Norihiko Kamioka, Emory University; Patrick Gleason, Emory University; Gaetano Paone, Emory University; Isida Byku, Emory University; Jasleen Tiwana, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda; James M McCabe, University of Washington; Krishna Cherukuri, Allegheny Health Network; Ramzi Khalil, Allegheny Health Network; David Lasorda, Allegheny Health Network; Sachin S Goel, Houston Methodist; Neal S Kleiman, Houston Methodist; Michael J Reardon, Houston Methodist; David V Daniels, Palo Alto Medical Foundation; Christian Spies, Palo Alto Medical Foundation; Paul Mahoney, MedStar Washington Hosp Ctr; Brian C Case, MedStar Washington Hospital Cente; Brian K Whisenant, Intermountain Healthcare; Pradeep K Yadav, Piedmont Heart Institute; Jose F Condado, Emory University; Rachel Koch, Emory University; Kendra Grubb, Emory University; Christopher G Bruce, University of Washington; Toby Rogers, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda; Robert Lederman, Emory University; Adam Greenbaum, Emory University
• Language: English
• Date: 2021-03-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Published by Elsevier on Behalf of the American College of Cardiology Foundation
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcin.2020.11.034
• Title of Journal or Parent Work: JACC-CARDIOVASCULAR INTERVENTIONS
• Volume: 14
• Issue: 5
• Start Page: 541
• End Page: 550
• Keywords: OUTFLOW TRACT OBSTRUCTION; mitral annuloplasty; transcatheter mitral valve replacement; left ventricular outflow tract obstruction; Life Sciences & Biomedicine; transcatheter electrosurgery; mitral regurgitation; Cardiovascular System & Cardiology; Science & Technology; LACERATION; LEAFLET; Cardiac & Cardiovascular Systems; mitral stenosis; surgical mitral valve replacement

Abstract

Objectives: The purpose of this study was to evaluate tip-to-base intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction (LAMPOON) in patients undergoing transcatheter mitral valve replacement (TMVR) in annuloplasty rings or surgical mitral valves. Background: LAMPOON is an effective adjunct to TMVR that prevents left ventricular outflow tract obstruction (LVOTO). Laceration is typically performed from the base to the tip of the anterior mitral leaflet. A modified laceration technique from leaflet tip to base may be effective in patients with a prosthesis that protects the aortomitral curtain. Methods: This is a multicenter, 21-patient, consecutive retrospective observational cohort. Patients underwent tip-to-base LAMPOON to prevent LVOTO and leaflet overhang, or therapeutically to lacerate a long anterior mitral leaflet risking or causing LVOTO. Outcomes were compared with findings from patients in the LAMPOON investigational device exemption trial with a prior mitral annuloplasty. Results: Twenty-one patients with a annuloplasty or valve prosthesis–protected mitral annulus underwent tip-to-base LAMPOON (19 preventive, 2 rescue). Leaflet laceration was successful in all and successfully prevented or treated LVOTO in all patients. No patients had significant LVOTO upon discharge. There were 2 cases of unintentional aortic valve injury (1 patient underwent emergency transcatheter aortic valve replacement and 1 patient underwent urgent surgical aortic valve replacement). In both cases, the patients had a supra-annular ring annuloplasty, and the retrograde aortic guiding catheter failed to insulate the guidewire lacerating surface from the aortic root. All patients survived to 30 days. Compared with classic retrograde LAMPOON, there was a trend toward shorter procedure time. Conclusions: Tip-to-base laceration is a simple, effective, and safe LAMPOON variant applicable to patients with an appropriately positioned mitral annular ring or bioprosthetic valve. Operators should take care to insulate the lacerating surface from adjacent structures.