Mitral Valve Leaflet Modification: A Working Group Position Statement on Best Practices and Step-by-Step Guide.

Publication Title

JACC Cardiovasc Interv

Authors

• James M McCabe
• Robert J Lederman
• David Elison
• Greg Condos
• Toby Rogers
• Amar Krishnaswamy
• Frederik Uttenthal
• Stephanie Sellers
• Prakriti Gaba
• Jeremy Rier
• Brian K Whisenant
• Paul D Mahoney
• Jeremiah P Depta
• Mohamed Abdel-Wahab
• Pinak B Shah
• Simon Cheung-Chi Lam
• Jason R Foerst
• Isida Byku
• Christine J Chung
• Christopher G Bruce
• Marvin H Eng
• Calvin Choi
• Roger J Laham
• Paolo Denti
• Mayra Guerrero
• Ho-On Alston Conrad Chiu
• John T Saxon
• Rajaram Anantharaman
• Logan L Vincent, Providence St. Vincent Medical Center, Portland, Oregon, USA.Follow
• Chun-Ka Wong
• Matteo Saccocci
• Ander Regueiro
• G Burkhard Mackensen
• Ignacio Amat-Santos
• Adam B Greenbaum
• Jaffar M Khan
• Vasilis C Babaliaros
• Phillip Freeman

Document Type

Article

Publication Date

6-22-2026

Keywords

Humans; Mitral Valve; Transcatheter Mitral Valve Replacement; Risk Factors; Treatment Outcome; Ventricular Outflow Obstruction, Left; Electrosurgery; Risk Assessment; Heart Valve Prosthesis; Consensus; Benchmarking; Recovery of Function; Predictive Value of Tests; Mitral Valve Annuloplasty; Prosthesis Design; LAMPOON; computed tomography; leaflet modification; left ventricular outflow tract obstruction; transcatheter electrosurgery; transcatheter mitral valve replacement.; oregon; portland; psvmc

Abstract

Left ventricular outflow tract (LVOT) obstruction is a potentially lethal complication of transcatheter mitral valve replacement (TMVR). The risk for LVOT obstruction can reliably be identified on preprocedural cardiac computed tomography. Intentional LAMPOON (laceration of the anterior mitral leaflet to prevent LVOT obstruction) and related techniques effectively prevent TMVR-induced LVOT obstruction, thereby expanding the treatable patient population. However, perceived technical complexity, the absence of purpose-built devices, and limited training opportunities have hindered the widespread adoption of mitral leaflet modification. This document synthesizes international experience to provide contemporary best-practice guidance for mitral leaflet modification. This state-of-the-art review details transcatheter electrosurgery principles, computed tomography-based risk analysis and procedural planning, a step-by-step guide to the LAMPOON technique, tips for managing uncommon challenges, and guidance on postprocedural care. These contemporary best practices can help operators achieve or maintain proficiency.

Area of Special Interest

Cardiovascular (Heart)

Specialty/Research Institute

Cardiology

DOI

https://www.ncbi.nlm.nih.gov/pubmed/42331404