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Press release
Monday, May 20th, 2019
The transcatheter approach increases treatment options for high-risk patients.
Researchers at the National Institute of Health, Lung and Blood (NHLBI), part of the National Institutes of Health, have come up with a new technique that prevents obstruction of blood flow, complicating fatal replacement of the mitral valve by transcatheter. The new method, called LAMPOON, may increase treatment options for high-risk patients previously ineligible for cardiac valve interventions. the Journal of the American College of Cardiology published the results online on May 20.
TMVR is used to treat mitral valve stenosis, a narrowing of the valve limiting blood flow in the main pumping chamber of the heart. It also deals with regurgitation, which occurs when the valve leaks and causes blood to flow back through the valve. Untreated, these conditions can cause pulmonary hypertension, cardiac hypertrophy, 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 introducing an artificial valve into a long, flexible, thin tube, called a catheter, into the blood vessels and into the heart. But in more than 50% of patients, the anatomy of the heart is an obstacle. The booklet of the heart is repulsed and blocks the blood circulation. This is what is called left ventricular outflow tract obstruction (OVVG), a common and most serious complication of TMVR.
"These patients have a failing mitral valve, can not undergo open heart surgery and are now rejected as candidates for TMVR because of the very high risk of obstruction of the left ventricular outflow tract," he said. said Jaffar M. Khan, MD, author of the study. clinician at NHLBI.
In order to increase the availability of TMVR for this subgroup of patients, Khan and his colleagues at NHLBI and Emory University have developed a procedure that consists of intentionally lacerating the prior mitral leaflet in order to prevent it from occurring. Obstruction of the left ventricular outflow tract, called LAMPOON.
During the LAMPOON procedure, the operator inserts two catheters into the patient's groin, then into the blood vessels until they reach the heart. The doctor then uses an electrified wire the size of a braided sewing thread in the catheter to open the leaflet. At this point, the patient is ready to undergo TMVR.
"Surgeons cut out the leaflets when they replace the leaflets. They can do this because they have opened the chest and heart and can clearly see the problem. LAMPOON is designed for patients who require a new mitral valve, but can not or do not wish to have open-heart surgery, "said Khan.
According to the researchers, other preventive strategies have had largely suboptimal results.
Between June 2017 and June 2018, the LAMPOON study included 30 patients aged 76 years on average, considered at high risk of surgical valve replacement and at prohibitive risk of obstruction of OTVG during RTMT .
All patients survived the procedure and 93% reached the 30-day survival threshold, which compares favorably with 38% reported with other methods. The main outcome of the study, which combined a successful LAMPOON, followed by a successful TMVR without reintervention, was achieved in 73% of patients.
The researchers hope this technique will eventually help reduce the number of deaths from heart valve disease. Each year, about five million people in the United States are diagnosed with heart valve disease and more than 20,000 Americans die each year, according to the American Heart Association.
About National Heart, Lung and Blood Institute (NHLBI): NHLBI is the world leader in leading and supporting research on heart, lung and blood diseases and sleep disorders that advances scientific knowledge, improves public health and saves lives. For more information, visit https://www.nhlbi.nih.gov.
About the National Institutes of Health (NIH):
The NIH, the country's medical research agency, has 27 institutes and centers and is part of the US Department of Health and Human Services. NIH is the lead federal agency that leads and supports basic, clinical and translational medical research. She studies causes, treatments and cures for common and rare diseases. For more information on NIH and its programs, visit www.nih.gov.
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Study
J. M. Khan et al. LAMPOON to prevent obstruction of OTVG during transcatheter mitral valve (TMVR) replacement: results of prospective multi-center trials. JACC. May 20, 2019. DOI: 10.1016 / j.jacc.2019.02.076
NHLBI DIR LAMPOON Study: Intentional laceration of the anterior mitral leaflet to prevent obstruction of the left ventricular outflow tract during the implantation of a mitral valve transcatheter https://clinicaltrials.gov/ a2 / show / NCT03015194
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