Tip-to-Base LAMPOON to Prevent Left Ventricular Outflow Tract Obstruction in Valve-in-Valve Transcatheter Mitral Valve Replacement

• Type of Material: Article
• Authors: Brian C. Case, MedStar Washington Hospital Center; Jaffar M. Khan, MedStar Washington Hospital Center; Lowell F. Satler, MedStar Washington Hospital Center; Itsik Ben-Dor, MedStar Washington Hospital Center; Robert Lederman, Emory University; Vasilis Babaliaros, Emory University; Adam Greenbaum, Emory University; Ron Waksman, MedStar Washington Hospital Center; Toby Rogers, MedStar Washington Hospital Center
• Language: English
• Date: 2020-05-11
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 the American College of Cardiology Foundation. Published by Elsevier.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcin.2020.01.235
• Title of Journal or Parent Work: JACC-CARDIOVASCULAR INTERVENTIONS
• Volume: 13
• Issue: 9
• Start Page: 1126
• End Page: 1128
• Grant/Funding Information: Dr. Khan has been a proctor for Edwards Lifesciences and Medtronic; and has been an inventor on patents, assigned to the NIH, on devices for transcatheter leaflet laceration. Dr. Lederman is an inventor on patents, assigned to the NIH, on devices for transcatheter leaflet laceration. Dr. Babaliaros has been a consultant for Edwards Lifesciences and Abbott Vascular; and has received institutional research support from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific. Dr. Greenbaum has been a proctor for Edwards Lifesciences, Medtronic, and Abbott Vascular; holds equity in Transmural Systems; and receives institutional research support from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific. Dr. Waksman has served on advisory boards for Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, and Pi-Cardia Ltd.; has been a consultant for Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, and Pi-Cardia Ltd.; has received grant support from AstraZeneca, Biotronik, Boston Scientific, and Chiesi; has served on the Speaker Bureau for AstraZeneca and Chiesi; and has been an investor in MedAlliance. Dr. Rogers has been a proctor for Edwards Lifesciences and Medtronic; and has been an inventor on patents, assigned to the NIH, on devices for transcatheter leaflet laceration. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
• Keywords: Science & Technology; valve-in-valve; transcatheter electrosurgery; Cardiovascular System & Cardiology; transcatheter mitral valve replacement; LAMPOON; Cardiac & Cardiovascular Systems; left ventricular outflow tract obstruction; Life Sciences & Biomedicine

Abstract

An 84-year-old woman with a history of a 29-mm bioprosthetic Mosaic (Medtronic, Minneapolis, Minnesota) mitral valve replacement presented with heart failure. Transesophageal echocardiography (TEE) demonstrated severe regurgitation (Figure 1A) from torn prosthetic leaflets (Figure 1B). Computed tomography revealed bioprosthetic leaflet near the septum in systole (Figure 1C). Predicted neo-left ventricular outflow tract (LVOT) using virtual 26-mm Sapien S3 (Edwards Lifesciences, Irvine, California) was 177.5 mm2 (Figure 1D). We performed a modification of laceration of the anterior mitral leaflet to prevent LVOT obstruction (LAMPOON) to achieve tip-to-base laceration of the bioprosthetic to prevent LVOT obstruction from valve-in-valve (ViV) transcatheter mitral valve replacement (TMVR).