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5-Year Outcomes of Anterior Mitral Leaflet Laceration to Prevent Outflow Obstruction

Jaffar M Khan1, Vasilis C Babaliaros2, Adam B Greenbaum3

  • 1Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA.

JACC. Cardiovascular Interventions
|September 7, 2024
PubMed
Abstract

Insights

Laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) safely enabled transcatheter mitral valve replacement in high-risk patients. Five-year follow-up showed no LAMPOON complications, though survival was limited by patient selection.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Left ventricular outflow tract (LVOT) obstruction is a critical complication of transcatheter mitral valve replacement (TMVR).
  • The Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON) procedure was previously shown to be safe and effective at preventing LVOT obstruction at 30 days.

Purpose of the Study:

  • To report the 5-year clinical and echocardiographic outcomes of intentional anterior mitral leaflet laceration prior to SAPIEN 3 TMVR.
  • To evaluate the safety and efficacy of the LAMPOON procedure in patients at high risk for LVOT obstruction.

Main Methods:

  • A prospective, multicenter, single-arm study (National Heart, Lung, and Blood Institute LAMPOON trial) assessed LAMPOON combined with transseptal SAPIEN 3 TMVR.
  • The study included patients with native mitral annular calcification (MAC) or in annuloplasty rings, all with high predicted risk for LVOT obstruction.
  • Primary endpoints were technical success and safety at 30 days; secondary endpoints included clinical and echocardiographic assessments at 1 year and clinical follow-up at 5 years.

Main Results:

  • LAMPOON was technically successful in all 30 enrolled subjects, with no strokes and low rates of death (3%) and moderate LVOT obstruction (3%) at 30 days.
  • Survival to 5 years was 25% (7/30), with 20% hospitalized for heart failure in the first year.
  • Significant improvements were observed from baseline to 1 year in quality of life (Kansas City Cardiomyopathy Questionnaire score +24 points) and functional capacity (6-minute walk distance +60 m), with sustained low LVOT gradients.

Conclusions:

  • The LAMPOON procedure effectively enabled TMVR in patients at risk of LVOT obstruction.
  • No long-term complications directly attributed to the LAMPOON procedure were observed.
  • The study population consisted of inoperable patients, which limited the assessment of long-term survival outcomes following TMVR.
Keywords:
LAMPOONleft ventricular outflow tract obstructionmitral annular calcificationmitral valve diseasetranscatheter electrosurgerytranscatheter mitral valve replacement

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