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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Mitral Valve Leaflet Modification: A Working Group Position Statement on Best Practices and Step-by-Step Guide
James M McCabe1, Robert J Lederman2, David Elison3
1Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Center for Innovation in Invasive Cardiology, Boston, Massachusetts, USA.
JACC. Cardiovascular Interventions
|June 22, 2026
Summary
Mitral leaflet modification techniques, like LAMPOON, prevent dangerous left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). This guidance synthesizes international experience to improve operator proficiency and expand TMVR patient eligibility.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Left ventricular outflow tract (LVOT) obstruction is a critical complication of transcatheter mitral valve replacement (TMVR).
- Preprocedural cardiac computed tomography accurately identifies patients at risk for LVOT obstruction.
- Mitral leaflet modification techniques, such as LAMPOON, are effective in preventing TMVR-induced LVOT obstruction.
Purpose of the Study:
- To provide contemporary best-practice guidance for mitral leaflet modification.
- To synthesize international experience and address barriers to adoption.
- To improve operator proficiency and expand the treatable patient population for TMVR.
Main Methods:
- Review of state-of-the-art techniques and international experience.
- Detailed explanation of transcatheter electrosurgery principles.
- Computed tomography-based risk analysis and procedural planning.
- Step-by-step guide to the LAMPOON technique and management of challenges.
Main Results:
- Mitral leaflet modification effectively prevents LVOT obstruction, expanding TMVR applicability.
- Guidance addresses perceived technical complexity and lack of purpose-built devices.
- Best practices aim to enhance operator proficiency in LAMPOON and related techniques.
Conclusions:
- Contemporary best-practice guidance for mitral leaflet modification is crucial for safe and effective TMVR.
- Standardized training and procedural techniques can overcome adoption barriers.
- Improved proficiency in leaflet modification expands treatment options for patients with mitral valve disease.
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