Management of Recurrent Mitral Regurgitation After Edge-to-Edge Repair Using Transcatheter Electrocautery Laceration and Valve Implantation.

OBJECTIVES

Recurrent mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER) poses significant clinical challenges, often requiring innovative solutions to address valve dysfunction. A technique combining anterior mitral leaflet laceration using the laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) technique, followed by transcatheter mitral valve replacement may be a novel strategy for managing complex recurrent MR after TEER in patients not deemed to be surgical candidates. The purpose of this report is to describe 2 cases which used this technique.

KEY STEPS

Preprocedural planning is crucial, and backup mechanical circulatory support should be considered. Native mitral valve is snared with electrocautery similar to the LAMPOON technique. The anterior leaflet is subsequently lacerated as close to the TEER device anteriorly as possible so that the device remains attached on the posterior valve to avoid left ventricular outflow tract (LVOT) obstruction. The transcatheter mitral valve is then deployed.

POTENTIAL PITFALLS

Potential pitfalls include the following: 1) LVOT obstruction despite care taken to entrap the TEER device posteriorly; 2) paravalvular leak; and 3) hemodynamic collapse from acute MR.

TAKE-HOME MESSAGES: Transcatheter electrosurgical laceration of the anterior leaflet of the mitral valve and subsequent placement of an Intrepid valve is an option to treat residual or recurrent MR in patients with prior TEER deemed not to be surgical candidates and/or patients with contraindication for a repeat TEER. Operators must plan for hemodynamic compromise and take care to lacerate the anterior leaflet as close to the device as possible to prevent LVOT obstruction.