Feature | Heart Valve Technology | May 22, 2019

New LAMPOON Technique Reduces LVOT Obstruction in Transcatheter Mitral Valve Replacement

The transcatheter approach increases treatment options for high-risk patients who need a mitral valve replacement procedure

Illustration showing the catheter steps for the LAMPOON procedure designed to prevent left ventricular outflow tract (LVOT) obstruction . From Dr. Jaffar M. Khan and the Laboratory of Cardiovascular Intervention, led by Dr. Robert J. Lederman.

Figure 1: Illustration showing the catheter steps for the LAMPOON procedure. From Dr. Jaffar M. Khan and the Laboratory of Cardiovascular Intervention, led by Dr. Robert J. Lederman.


Researchers at the National, Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), developed a novel technique that prevents the obstruction of blood flow in the left ventricular outflow tract (LVOT) during transcatheter mitral valve replacement (TMVR). LVOT obstruction  is a common fatal complication of TMVR, due to the close proximity off the aortic and mitral valves and the potential overhang of transcatheter valve blocking flow through the LVOT. 

The new method called LAMPOON might increase treatment options for high-risk surgical patients who previously were ineligible for heart valve procedures. The Journal of the American College of Cardiology published the findings online May 20.[1] See Figure 1 for an illustration of the procedure.

TMVR is used to treat mitral valve stenosis and regurgitation. Untreated, these conditions can cause pulmonary hypertension, heart enlargement, atrial fibrillation, blood clots, and heart failure. 

For elderly or frail patients, TMVR offers a less-invasive alternative to open heart surgery. During TMVR, doctors replace the mitral valve by delivering an artificial valve through a catheter. But in more than 50 percent of patients, the heart’s anatomy gets in the way. The heart leaflet is pushed back and blocks blood flow, causing LVOT obstruction. See Figure 2 for an illustration of LVOT obstruction. 

“These patients have a failing mitral valve, are not able to undergo open heart surgery, and are now rejected as candidates for TMVR because of the very high risk of left ventricular outflow tract obstruction,” said study author Jaffar M. Khan, M.D., clinician at NHLBI.

To increase the availability of TMVR for this subset of patients, Khan and colleagues at NHLBI and Emory University developed a procedure that makes an intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction, dubbed LAMPOON.

 

Overview of the LAMPOON Procedure

In the LAMPOON procedure, the operator inserts two catheters through the patient’s groin, and then through the blood vessels until it reaches the heart. The doctor then uses an electrified wire the size of a sewing thread woven through the catheter to split open the leaflet. At that point, the patient is ready to undergo TMVR.

“Surgeons cut out the leaflets when they replace valves. They can do it, because they have cut open the chest and the heart and can clearly see the problem. LAMPOON is designed for patients who need a new mitral valve, but can’t, or may not want to undergo open heart surgery,” said Khan.

According to the researchers, other preventive strategies have had largely suboptimal outcomes.

 

LAMPOON Study Data Shows Increased Survival

Between June 2017 and June 2018, the LAMPOON Study enrolled 30 patients, median age 76, considered at high risk for surgical valve replacement and at prohibitive risk of LVOT obstruction during TMVR.[2]

All patients survived the procedure and 93 percent reached the 30-day survival mark, which compares favorably to a 38 percent reported with other methods. The primary outcome of the study, which combined a successful LAMPOON, followed by a successful TMVR without re-intervention, was achieved in 73 percent of the patients. 

The researchers hope the technique will eventually help reduce the number of deaths from heart valve disease. Every year, approximately 5 million people in the United States are diagnosed with heart valve disease, and more than 20,000 Americans die of the disease each year, according to the American Heart Association (AHA). 

Watch the VIDEO: Jaffar Khan discusses the development of LAMPOON and BASILICA procedures from bench to bedside.

Read the related article "Henry Ford Hospital Cardiologist Performs Pioneering Laser Mitral Valve Treatment," from the LAMPOON Study.

 

About the National Heart, Lung, and Blood Institute (NHLBI) is part of the National Institutes of Health (NIH). NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information: www.nhlbi.nih.gov.

 

Related Mitral LVOT Obstruction Content:

VIDEO: The Importance of the Neo-LVOT in Transcatheter Mitral Valve Replacement — Interview with Dee Dee Wang, M.D.,

The Essentials of Structural Heart Imaging

VIDEO: Evaluation Tool for Neo-LVOT in Transcatheter Mitral Valve Procedures

BASILICA Procedure Prevents Coronary Obstruction From TAVR
 

References:
1. J. M. Khan et al. LAMPOON to prevent LVOT Obstruction during Transcatheter Mitral Valve Replacement (TMVR): Prospective Multicenter Trial Results. JACC. May 20, 2019. DOI: 10.1016/j.jacc.2019.02.076.

2. NHLBI DIR LAMPOON Study: Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Implantation https://clinicaltrials.gov/ct2/show/NCT03015194


Related Content

News | Cardiovascular Clinical Studies

October 4, 2022 — Lexicon Pharmaceuticals, Inc. announced that a new analysis of results from the SOLOIST-WHF Phase ...

Home October 04, 2022
Home
News | Cardiovascular Clinical Studies

September 8, 2022 — A clinical trial led by investigators from Brigham and Women’s Hospital has found that the long-term ...

Home September 08, 2022
Home
News | Cardiovascular Clinical Studies

August 17, 2022 — A study carried out by scientists at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) ...

Home August 17, 2022
Home
News | Cardiovascular Clinical Studies

August 12, 2022 — Older adults with atrial cardiopathy (a major, often undetected cardiac cause of stroke) may be at ...

Home August 12, 2022
Home
News | Cardiovascular Clinical Studies

August 8, 2022 — Two years ago, University of Alabama at Birmingham researchers and colleagues reported that reductive ...

Home August 08, 2022
Home
News | Cardiovascular Clinical Studies

July 22, 2022 — BioSig Technologies, Inc. a medical technology company advancing electrophysiology workflow by ...

Home July 22, 2022
Home
News | Cardiovascular Clinical Studies

July 18, 2022 — scPharmaceuticals Inc., a pharmaceutical company focused on developing and commercializing products that ...

Home July 19, 2022
Home
News | Cardiovascular Clinical Studies

July 15, 2022 — Imagine, if scientists had a map of the heart, so granular in its accuracy that it even profiled details ...

Home July 15, 2022
Home
News | Cardiovascular Clinical Studies

July 11, 2022 — Smoking traditional or non-combustible cigarettes while wearing a surgical mask results in a two-fold ...

Home July 12, 2022
Home
News | Cardiovascular Clinical Studies

June 24, 2022 — Henry Ford Health was part of a multi-institutional heart failure study that was launched and executed ...

Home June 24, 2022
Home
Subscribe Now