LAMPOON Technique and Transapical Wire Externalization During Transcatheter Mitral Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Mitral surgical repair can fail, necessitating alternative treatment strategies.
• Transcatheter valve-in-ring replacement is an option for complex mitral valve cases.
• High-risk patients may face challenges like valve misalignment and left ventricular outflow obstruction.

Purpose of the Study:

• To describe the successful use of transcatheter mitral valve-in-ring replacement in a patient with prior failed mitral repair.
• To detail the application of novel techniques to mitigate procedural risks.

Main Methods:

• A 74-year-old woman with a history of failed mitral surgical repair underwent transcatheter mitral valve-in-ring replacement.
• Pre-procedural imaging identified risks of valve misalignment and left ventricular outflow obstruction.
• The electrosurgical laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) technique was utilized.
• Transapical wire externalization was employed for valve deployment.

Main Results:

• The combined techniques successfully prevented valve misalignment.
• Left ventricular outflow obstruction was effectively avoided.
• The transcatheter mitral valve-in-ring replacement procedure was technically successful.

Conclusions:

• Transcatheter mitral valve-in-ring replacement is a viable option for patients with failed mitral repair.
• The LAMPOON technique and transapical wire externalization are effective in preventing major complications during these procedures.