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

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Left ventricular outflow tract obstruction (LVOTO) is a complication of transcatheter mitral valve replacement (TMVR).
• The LAMPOON procedure, typically performed base-to-tip, lacerates the anterior mitral leaflet to prevent LVOTO.
• A modified tip-to-base LAMPOON technique may be beneficial in patients with prosthetic rings or valves.

Purpose of the Study:

• To evaluate the safety and efficacy of a tip-to-base LAMPOON technique.
• To assess its utility in preventing or treating LVOTO in patients undergoing TMVR with annuloplasty rings or surgical valves.

Main Methods:

• A multicenter, retrospective observational study of 21 patients.
• Patients underwent tip-to-base LAMPOON, either preventively or therapeutically.
• Outcomes were compared to historical data from the LAMPOON investigational device exemption trial.

Main Results:

• Tip-to-base LAMPOON was technically successful in all patients, preventing or treating LVOTO.
• No significant LVOTO was observed at discharge.
• Two cases of unintentional aortic valve injury occurred in patients with supra-annular rings; both required aortic valve replacement. All patients survived 30 days.

Conclusions:

• Tip-to-base LAMPOON is a safe, simple, and effective variant for patients with mitral annular rings or bioprosthetic valves.
• Careful insulation of the lacerating surface is crucial to prevent adjacent structure injury.
• This technique offers a viable option for managing LVOTO in specific TMVR scenarios.