Transcaval SESAME, LAMPOON, and Valve-in-MAC: First Experience With SESAME Outside the United States

The SESAME (SEptal Scoring Along Midline Endocardium) procedure is early in its evolution but seems to be an effective adjunct to facilitate transcatheter mitral valve replacement (TMVR) in patients with complex anatomy.

An 80-year-old woman was admitted with pulmonary edema and diagnosed with severe mitral annular calcification (MAC) and significant mixed mitral disease prohibitive for surgery. She had a history of hypertrophic obstructive cardiomyopathy previously treated with alcohol septal ablation. We performed a SESAME followed by LAMPOON (Laceration of the Anterior Mitral leaflet to Prevent Outflow ObstructioN) to enable a successful transcatheter valve-in-MAC.

Valve-in-MAC constitutes a high risk for major complications. This case demonstrates an approach with different minimally invasive electrosurgical procedures to enable successful TMVR.

The case highlights the importance of collaboration, pre- and intraprocedural imaging, and preparation in order to predict and prevent the risk of iatrogenic left ventricular outflow tract obstruction when performing TMVR in complex patients.