How to Do It: Preventing LVOT Obstruction Valve-in-Valve TMVR

<p><em>This article is part of CTSNet’s Guest Editor Series,</em> 21 Years After First TAVI: Will Pace of Innovations Continue for All Heart Valves? <em>Guest editor Gry Dahle has curated a robust collection of content that shares the knowledge, techniques, and insights of several distinguished experts from around the world. </em></p> <p>LVOT obstruction after TMVI has very poor outcomes and is related to both a fixed obstruction—a narrowed and elongated neo-LVOT caused by the anterior mitral leaflet being pushed toward the inter ventricular septum—and a dynamic obstruction (SAM). Although the second one is more difficult to predict, the first one can be predicted through accurate preprocedural CT planning and sizing. A step-by-step approach is shown in this video.</p> <p>This video demonstrates valve-in-valve transeptal transcatheter mitral valve implantation (TMVI) in a high-risk patient. The authors show a combination of all the techniques used to prevent the risk of left ventricular outflow tract (LVOT) obstruction: the septal alcohol ablation and the Lampoon technique (tip-to-base approach) with the implantation of a Sentinel device (for cerebral protection) due to the presence of a left atrial thrombus in a patient with hyperthrophic cardiomyopathy and prior aortic and mitral valve replacement.</p>