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Author Notes:

Address for correspondence: Dr. Robert J. Lederman, Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, Maryland 20892-1538. lederman@nih.gov

The authors thank Lauren Wheeler, Jonathan Mazal, Bill Schenke, Annette Stine, Adriana Byrnes, Sharon Howell, Ioannis Para-statidis, Frank Corrigan, Patricia Keegan, Amy Simone, Ateet Patel, Jessica Forcillo, Kelly Broxton, Neil Holtz, Deborah Dunn, Andrew Youmans, Benjamin Maples, James Lee, Nancy Sarpong, Ronnie Ramadan, Talal Alatassi, and Vicki Smith for patient care and data management; and Alan Hoofring of National Institutes of Health Division of Medical Arts.

Dr. Babaliaros is a consultant for Edwards Lifesciences and Abbott Vascular; and his employer has research contracts from Edwards Lifesciences, Abbott Vascular, Medtronic, St Jude Medical, and Boston Scientific.

Dr. Greenbaum is a proctor for Edwards Lifesciences and St Jude Medical.

Dr. O’Neill is a consultant for Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Vascular, and St. Jude Medical; and serves on the Board of Directors of Neovasc Inc.

Dr. Thourani is a consultant for Edwards Lifesciences.

Dr. Lerakis is a consultant for Edwards Lifesciences and Abbott Vascular.

Dr. Kim is a consultant for Edwards Lifesciences; and a proctor for B. Braun.

Subject:

Research Funding:

Supported without industry funding by the clinical programs of the Structural Heart and Valve Center, Emory University Hospital; the Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System; and the Division of Intramural Research (Z01-HL006040), National Heart Lung and Blood Institute, National Institutes of Health.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • left ventricular outflow tract obstruction
  • mitral valve
  • structural heart disease
  • transcatheter mitral valve replacement
  • valvular heart disease
  • PREDICTING LVOT OBSTRUCTION
  • ALCOHOL SEPTAL ABLATION
  • TRACT OBSTRUCTION
  • ANNULAR CALCIFICATION
  • AORTIC-STENOSIS
  • SAPIEN XT
  • IN-VALVE
  • IMPLANTATION
  • RADIOFREQUENCY
  • ACCESS

Intentional Percutaneous Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction During Transcatheter Mitral Valve Replacement First-in-Human Experience

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Journal Title:

JACC: Cardiovascular Interventions

Volume:

Volume 10, Number 8

Publisher:

, Pages 798-809

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objectives: This study sought to use a new catheter technique to split the anterior mitral valve leaflet (AML) and prevent iatrogenic left ventricular outflow tract (LVOT) obstruction immediately before transcatheter mitral valve replacement (TMVR). Background: LVOT obstruction is a life-threatening complication of TMVR, caused by septal displacement of the AML. Methods: The procedure was used in patients with severe mitral valve disease and prohibitive surgical risk. Patients either had prior surgical mitral valve ring (n = 3) or band annuloplasty (n = 1) or mitral annular calcification with stenosis (n = 1). Iatrogenic LVOT obstruction or transcatheter heart valve dysfunction was predicted in all based on echocardiography and computed tomography. Transfemoral coronary guiding catheters directed an electrified guidewire across the center and base of the AML toward a snare in the left atrium. The externalized guidewire loop was then electrified to lacerate the AML along the centerline from base to tip, sparing chordae, immediately before transseptal TMVR. Results: Five patients with prohibitive risk of LVOT obstruction or transcatheter heart valve dysfunction from TMVR successfully underwent LAMPOON, with longitudinal splitting of the A2 scallop of the AML, before valve implantation. Multiplane computed tomography modeling predicted hemodynamic collapse from TMVR assuming an intact AML. However, critical LVOT gradients were not seen following LAMPOON and TMVR. Doppler blood flow was seen across transcatheter heart valve struts that encroached the LVOT, because the AML was split. Transcatheter heart valve function was unimpeded. Conclusions: This novel catheter technique, which resembles surgical chord-sparing AML resection, may enable TMVR in patients with prohibitive risk of LVOT obstruction or transcatheter heart valve dysfunction.

Copyright information:

© 2017 Elsevier B.V. or its licensors or contributors.

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