Vasilis C Babaliaros1, Adam B Greenbaum2, Jaffar M Khan3, Toby Rogers3, Dee Dee Wang2, Marvin H Eng2, William W O'Neill2, Gaetano Paone2, Vinod H Thourani1, Stamatios Lerakis1, Dennis W Kim4, Marcus Y Chen3, Robert J Lederman5. 1. Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia. 2. Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan. 3. Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. 4. Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia. 5. Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: lederman@nih.gov.
Abstract
OBJECTIVES: This study sought to use a new catheter technique to split the anterior mitral valve leaflet (AML) and prevent iatrogenic left ventricular outflow tract (LVOT) obstruction immediately before transcatheter mitral valve replacement (TMVR). BACKGROUND: LVOT obstruction is a life-threatening complication of TMVR, caused by septal displacement of the AML. METHODS: The procedure was used in patients with severe mitral valve disease and prohibitive surgical risk. Patients either had prior surgical mitral valve ring (n = 3) or band annuloplasty (n = 1) or mitral annular calcification with stenosis (n = 1). Iatrogenic LVOT obstruction or transcatheter heart valve dysfunction was predicted in all based on echocardiography and computed tomography. Transfemoral coronary guiding catheters directed an electrified guidewire across the center and base of the AML toward a snare in the left atrium. The externalized guidewire loop was then electrified to lacerate the AML along the centerline from base to tip, sparing chordae, immediately before transseptal TMVR. RESULTS: Five patients with prohibitive risk of LVOT obstruction or transcatheter heart valve dysfunction from TMVR successfully underwent LAMPOON, with longitudinal splitting of the A2 scallop of the AML, before valve implantation. Multiplane computed tomography modeling predicted hemodynamic collapse from TMVR assuming an intact AML. However, critical LVOT gradients were not seen following LAMPOON and TMVR. Doppler blood flow was seen across transcatheter heart valve struts that encroached the LVOT, because the AML was split. Transcatheter heart valve function was unimpeded. CONCLUSIONS: This novel catheter technique, which resembles surgical chord-sparing AML resection, may enable TMVR in patients with prohibitive risk of LVOT obstruction or transcatheter heart valve dysfunction. Published by Elsevier Inc.
OBJECTIVES: This study sought to use a new catheter technique to split the anterior mitral valve leaflet (AML) and prevent iatrogenic left ventricular outflow tract (LVOT) obstruction immediately before transcatheter mitral valve replacement (TMVR). BACKGROUND:LVOT obstruction is a life-threatening complication of TMVR, caused by septal displacement of the AML. METHODS: The procedure was used in patients with severe mitral valve disease and prohibitive surgical risk. Patients either had prior surgical mitral valve ring (n = 3) or band annuloplasty (n = 1) or mitral annular calcification with stenosis (n = 1). Iatrogenic LVOT obstruction or transcatheter heart valve dysfunction was predicted in all based on echocardiography and computed tomography. Transfemoral coronary guiding catheters directed an electrified guidewire across the center and base of the AML toward a snare in the left atrium. The externalized guidewire loop was then electrified to lacerate the AML along the centerline from base to tip, sparing chordae, immediately before transseptal TMVR. RESULTS: Five patients with prohibitive risk of LVOT obstruction or transcatheter heart valve dysfunction from TMVR successfully underwent LAMPOON, with longitudinal splitting of the A2 scallop of the AML, before valve implantation. Multiplane computed tomography modeling predicted hemodynamic collapse from TMVR assuming an intact AML. However, critical LVOT gradients were not seen following LAMPOON and TMVR. Doppler blood flow was seen across transcatheter heart valve struts that encroached the LVOT, because the AML was split. Transcatheter heart valve function was unimpeded. CONCLUSIONS: This novel catheter technique, which resembles surgical chord-sparing AML resection, may enable TMVR in patients with prohibitive risk of LVOT obstruction or transcatheter heart valve dysfunction. Published by Elsevier Inc.
Authors: Nadira B Hamid; Omar K Khalique; Mark J Monaghan; Susheel K Kodali; Danny Dvir; Vinayak N Bapat; Tamim M Nazif; Torsten Vahl; Isaac George; Martin B Leon; Rebecca T Hahn Journal: JACC Cardiovasc Imaging Date: 2015-08
Authors: Pierre Deharo; Marina Urena; Dominique Himbert; Eric Brochet; Frederic Rouleau; Frederic Pinaud; Stephane Delepine; Jose Luis Carrasco; Walid Ghodbane; Fabrice Extramiana; Phalla Ou; Marie Pierre Dilly; David Messika-Zeitoun; Bernard Iung; Patrick Nataf; Alec Vahanian Journal: JACC Cardiovasc Interv Date: 2016-03-23 Impact factor: 11.195
Authors: Mackram F Eleid; Allison K Cabalka; Matthew R Williams; Brian K Whisenant; Oluseun O Alli; Neil Fam; Peter M Pollak; Firas Barrow; Joseph F Malouf; Rick A Nishimura; Lyle D Joyce; Joseph A Dearani; Charanjit S Rihal Journal: JACC Cardiovasc Interv Date: 2016-04-13 Impact factor: 11.195
Authors: Adam B Greenbaum; Jose F Condado; Marvin Eng; Stamatios Lerakis; Dee Dee Wang; Dennis W Kim; Robert J Lederman; Gaetano Paone; William W O Neill; Vinod H Thourani; Vasilis C Babaliaros Journal: Catheter Cardiovasc Interv Date: 2017-05-04 Impact factor: 2.692
Authors: Majdi Halabi; Kanishka Ratnayaka; Anthony Z Faranesh; Marcus Y Chen; William H Schenke; Robert J Lederman Journal: J Am Coll Cardiol Date: 2013-04-02 Impact factor: 24.094
Authors: Keshav Kohli; Zhenglun Alan Wei; Vahid Sadri; Tiffany Netto; John C Lisko; Adam B Greenbaum; Vasilis Babaliaros; John N Oshinski; Ajit P Yoganathan Journal: Ann Biomed Eng Date: 2021-03-15 Impact factor: 3.934
Authors: Jaffar M Khan; Danny Dvir; Adam B Greenbaum; Vasilis C Babaliaros; Toby Rogers; Gabriel Aldea; Mark Reisman; G Burkhard Mackensen; Marvin H K Eng; Gaetano Paone; Dee Dee Wang; Robert A Guyton; Chandan M Devireddy; William H Schenke; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2018-04-09 Impact factor: 11.195
Authors: Robert J Lederman; Vasilis C Babaliaros; Toby Rogers; Jaffar M Khan; Norihiko Kamioka; Danny Dvir; Adam B Greenbaum Journal: JACC Cardiovasc Interv Date: 2019-07-08 Impact factor: 11.195
Authors: Jaffar M Khan; Vasilis C Babaliaros; Adam B Greenbaum; Jason R Foerst; Shahram Yazdani; James M McCabe; Gaetano Paone; Marvin H Eng; Bradley G Leshnower; Patrick T Gleason; Marcus Y Chen; Dee Dee Wang; Xin Tian; Annette M Stine; Toby Rogers; Robert J Lederman Journal: J Am Coll Cardiol Date: 2019-05-28 Impact factor: 24.094
Authors: Jaffar M Khan; Adam B Greenbaum; Vasilis C Babaliaros; Toby Rogers; Marvin H Eng; Gaetano Paone; Bradley G Leshnower; Mark Reisman; Lowell Satler; Ron Waksman; Marcus Y Chen; Annette M Stine; Xin Tian; Danny Dvir; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2019-06-12 Impact factor: 11.195
Authors: Vasilis Babaliaros; Adam B Greenbaum; Norihiko Kamioka; Jaffar M Khan; Toby Rogers; Frank Corrigan; Stamatios Lerakis; Patrick Gleason; Altayyeb Yousef; Dennis W Kim; Neil Holtz; Bradley Leshnower; Robert A Guyton; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2018-06-25 Impact factor: 11.195
Authors: Jaffar M Khan; Robert J Lederman; Chandan M Devireddy; Stephen D Clements; Norihiko Kamioka; Altayyeb Yousef; Patrick T Gleason; Robert A Guyton; Vasilis C Babaliaros Journal: JACC Cardiovasc Interv Date: 2018-10-08 Impact factor: 11.195