Transcatheter Mitral Valve Replacement With LAMPOON

Left ventricular outflow tract (LVOT) obstruction is a potentially fatal complication of transcatheter mitral valve replacement (TMVR), particularly in patients with anatomically high-risk features. LAMPOON (laceration of the anterior mitral leaflet to prevent outflow obstruction) is a transcatheter electrosurgical technique developed to mitigate this risk by modifying anterior mitral leaflet anatomy prior to valve deployment.

We describe our institutional experience with LAMPOON as a preventive strategy in TMVR cases with a high predicted risk for neo-LVOT obstruction.

This case series includes patients with high-risk anatomical features who underwent TMVR with LAMPOON. Variations of the LAMPOON technique, including antegrade and tip-to-base approaches using the "flying-V" electrosurgical wire configuration, were employed based on individual anatomy.

All patients underwent successful anterior mitral leaflet laceration, with no significant LVOT obstruction. Antegrade and tip-to-base LAMPOON techniques are safe and effective adjuncts to TMVR in patients at high risk of LVOT obstruction.