Anterior Leaflet Laceration to Prevent Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Replacement

Left ventricular outflow tract (LVOT) obstruction is a leading cause of mortality and exclusion from transcatheter mitral valve replacement (TMVR). Intentional laceration of the anterior mitral valve leaflet to prevent LVOT obstruction (LAMPOON) is a transcatheter mimic of surgical chord-sparing lea...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2019-05, Vol.73 (20), p.2521-2534
Main Authors: Khan, Jaffar M., Babaliaros, Vasilis C., Greenbaum, Adam B., Foerst, Jason R., Yazdani, Shahram, McCabe, James M., Paone, Gaetano, Eng, Marvin H., Leshnower, Bradley G., Gleason, Patrick T., Chen, Marcus Y., Wang, Dee Dee, Tian, Xin, Stine, Annette M., Rogers, Toby, Lederman, Robert J.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Alcohol
Calcification
Cardiac Catheterization - methods
Cardiology
Cardiovascular diseases
Catheters
Computed tomography
Echocardiography
Echocardiography, Transesophageal
Electrosurgery - methods
Female
Follow-Up Studies
Heart
Heart Septum - diagnostic imaging
Heart Septum - surgery
Heart Valve Diseases - complications
Heart Valve Diseases - diagnosis
Heart Valve Diseases - surgery
Heart Valve Prosthesis Implantation - methods
Humans
Implantation
Intraoperative Period
Laboratories
Male
Mercury
Middle Aged
mitral annular calcification
Mitral valve
Mitral Valve - diagnostic imaging
Mitral Valve - surgery
Mortality
Prospective Studies
structural heart disease
Surgery
Survival
Tomography
Tomography, X-Ray Computed
transcatheter electrosurgery
transcatheter mitral valve replacement
transseptal interventions
Treatment Outcome
valve-in-ring
Vascular implants
Ventricle
Ventricular Outflow Obstruction - diagnosis
Ventricular Outflow Obstruction - etiology
Ventricular Outflow Obstruction - prevention & control
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Description
Summary:Left ventricular outflow tract (LVOT) obstruction is a leading cause of mortality and exclusion from transcatheter mitral valve replacement (TMVR). Intentional laceration of the anterior mitral valve leaflet to prevent LVOT obstruction (LAMPOON) is a transcatheter mimic of surgical chord-sparing leaflet resection. The purpose of this prospective multicenter trial was to study LAMPOON with transseptal (Edwards Lifesciences, Irvine, California) TMVR in annuloplasty rings or native mitral annular calcification (MAC). Subjects at high or extreme surgical risk and prohibitive risk of LVOT obstruction from TMVR were included. Eligibility was modified midtrial to exclude subjects with threatened LVOT obstruction from a Sapien 3 valve fabric skirt. The primary endpoint was procedure survival with successful LAMPOON, with successful TMVR, without reintervention, and with LVOT gradient 
ISSN:0735-1097
1558-3597
1558-3597
DOI:10.1016/j.jacc.2019.02.076