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Lin HC, Lee YT, Tsao TP, Lee KC, Hsiung MC, Yin WH, Wei J. A Modified Tip-to-Base LAMPOON to Prevent Left Ventricular Outflow Tract Obstruction in Valve-in-Ring or Valve-in-Valve Transcatheter Mitral Valve Replacement. ACTA CARDIOLOGICA SINICA 2024; 40:331-339. [PMID: 38779166 PMCID: PMC11106618 DOI: 10.6515/acs.202405_40(3).20240129a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/29/2024] [Indexed: 05/25/2024]
Abstract
Background The Laceration of the Anterior Mitral leaflet to Prevent Outflow ObtructioN (LAMPOON) procedure may be performed from the leaflet tip to base to prevent left ventricular outflow tract obstruction (LVOTO) in patients with high-risk anatomy undergoing valve-in-valve (VIV) or valve-in-(complete)-ring (VIR) transcatheter mitral valve replacement (TMVR). Methods and Results Thirteen consecutive patients (6 females, average age 67.7 years) with a mean left ventricular ejection fraction of 60%, a median STS score of 3.2%, and degenerative surgical mitral bioprosthesis or ring were treated with a combined, single-stage procedure of preventive LAMPOON and trans-septal TMVR with SAPIEN 3 valves (Edwards Lifesciences, Irvine, CA). Under real-time 3-dimensional transesophageal echocardiography (RT 3D-TEE) guidance, we included the rendezvous technique in the LAMPOON procedure, and all 13 patients were successfully treated by tip-to-base LAMPOON and TMVR. The use of a modified LAMPOON procedure, aided by a rendezvous technique and guided by RT 3D-TEE imaging, offers precise guidance for positioning and aligning the guidewire. This approach not only reduces the need for fluoroscopy and shortens procedure times, but also significantly increases the likelihood of a successful outcome. Importantly, none of the patients in our study experienced unintentional aortic or aortic valve injuries, nor did they develop significant LVOTO following TMVR. In 11 of the 13 (85%) patients, we used a transcatheter SENTINELTM cerebral protection device (Boston Scientific, Marlborough, MA) for stroke prevention and capture of debris ≥ 2 mm were detected in 8/11 (73%) of the cases. Conclusions Utilizing intra-operative RT 3D-TEE in conjunction with the rendezvous technique can make the tip-to-base LAMPOON procedure even safer and more effective for patients undergoing VIV or VIR TMVR. Our study also suggests that cerebral protection is indicated in patients undergoing TMVR.
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Affiliation(s)
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital
- Institute of Microbiology and Immunology, School of Medicine, National Yang Ming Chiao Tung University
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital
- Faculty of Medicine, National Defense Medical Center
| | | | | | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital
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Kohli K, Wei ZA, Sadri V, Siefert AW, Blanke P, Perdoncin E, Greenbaum AB, Khan JM, Lederman RJ, Babaliaros VC, Yoganathan AP, Oshinski JN. Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study. Front Cardiovasc Med 2022; 9:869259. [PMID: 35811698 PMCID: PMC9261975 DOI: 10.3389/fcvm.2022.869259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background A clinical study comparing the hemodynamic outcomes of transcatheter mitral valve replacement (TMVR) with vs. without Laceration of the Anterior Mitral leaflet to Prevent Outflow Obstruction (LAMPOON) has never been designed nor conducted. Aims To quantify the hemodynamic impact of LAMPOON in TMVR using patient-specific computational (in silico) models. Materials Eight subjects from the LAMPOON investigational device exemption trial were included who had acceptable computed tomography (CT) data for analysis. All subjects were anticipated to be at prohibitive risk of left ventricular outflow tract (LVOT) obstruction from TMVR, and underwent successful LAMPOON immediately followed by TMVR. Using post-procedure CT scans, two 3D anatomical models were created for each subject: (1) TMVR with LAMPOON (performed procedure), and (2) TMVR without LAMPOON (virtual control). A validated computational fluid dynamics (CFD) paradigm was then used to simulate the hemodynamic outcomes for each condition. Results LAMPOON exposed on average 2 ± 0.6 transcatheter valve cells (70 ± 20 mm2 total increase in outflow area) which provided an additional pathway for flow into the LVOT. As compared to TMVR without LAMPOON, TMVR with LAMPOON resulted in lower peak LVOT velocity, lower peak LVOT gradient, and higher peak LVOT effective orifice area by 0.4 ± 0.3 m/s (14 ± 7% improvement, p = 0.006), 7.6 ± 10.9 mmHg (31 ± 17% improvement, p = 0.01), and 0.2 ± 0.1 cm2 (17 ± 9% improvement, p = 0.002), respectively. Conclusion This was the first study to permit a quantitative, patient-specific comparison of LVOT hemodynamics following TMVR with and without LAMPOON. The LAMPOON procedure achieved a critical increment in outflow area which was effective for improving LVOT hemodynamics, particularly for subjects with a small neo-left ventricular outflow tract (neo-LVOT).
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Affiliation(s)
- Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- *Correspondence: Keshav Kohli,
| | - Zhenglun Alan Wei
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, United States
| | - Vahid Sadri
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Andrew W. Siefert
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Philipp Blanke
- Department of Radiology, St. Paul’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Emily Perdoncin
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, United States
| | - Adam B. Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, United States
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Vasilis C. Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, United States
| | - Ajit P. Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - John N. Oshinski
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA, United States
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Kılıç T, Coşkun Ş, Çakır Ö, Isravilov R, Yavuz Ş, Hoşten T, Şahin T. Tip-to-base LAMPOON to prevent left ventricular outflow tract obstruction in a valve-in-ring transcatheter mitral valve replacement: First LAMPOON procedure in Turkey and first LAMPOON case for transseptal Myval™ implantation. Anatol J Cardiol 2021; 25:363-367. [PMID: 33960314 DOI: 10.5152/anatoljcardiol.2021.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Teoman Kılıç
- Department of Cardiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Şenol Coşkun
- Department of Cardiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Özgür Çakır
- Department of Radiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Revan Isravilov
- Department of Cardiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Şadan Yavuz
- Department of Cardiovascular Surgery, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Tülay Hoşten
- Department of Anesthesiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
| | - Tayfun Şahin
- Department of Cardiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
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Lloyd JW, Rihal CS, Eleid MF. Hemodynamics rounds: Hemodynamics of mitral valve interventions. Catheter Cardiovasc Interv 2020; 96:712-724. [PMID: 32034874 DOI: 10.1002/ccd.28755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 12/23/2022]
Abstract
Mitral valvulopathy presents as regurgitation, stenosis, or mixed disease and can occur in both native and prosthetic valves. Such disease develops in conjunction with pathophysiologic changes in the left atrium (LA) and drives changes in LA compliance, pressure, and thus clinical syndromes. With advances in the understanding and treatment of structural heart disease and in the setting of higher-risk patient populations, less-invasive transcatheter approaches have become increasingly commonplace in the treatment of mitral valve disease. Over time, transcatheter mitral valve interventions have evolved to include paravalvular leak closure, mitral valve repair, and mitral valve replacement. Parallel to this evolution, advances in invasive intracardiac pressure monitoring, particularly at the level of the LA, have also occurred. These advances emphasize the unique interplay between mitral valve disease and LA function; account for limitations of noninvasive assessment; and guide beneficial outcomes in each area of transcatheter mitral valve intervention. As a result, continuous transseptal LA pressure monitoring has developed into an indispensable instrument in successful percutaneous mitral valve intervention, complementing traditional noninvasive assessment.
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Affiliation(s)
- James W Lloyd
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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