Transcatheter, transapical mitral valve replacement (TMVR) using the Tendyne©  device (Abbott Laboratories, Abbott Park, Illinois, USA) is a novel technique to treat severe mitral regurgitation without the use of cardiopulmonary bypass or sternotomy, which can be advantageous for older patients with multiple comorbidities. A potential complication of TMVR includes the dynamic obstruction of the left ventricular outflow tract (LVOT) by the native anterior mitral valve leaflet, which may result in systolic anterior motion. Anatomical characteristics that are associated with a dynamic obstruction are identified during the (pre)screening process. These patients are not eligible for TMVR. Up to 31.7% of (pre)screening failures are due to the fear of LVOT occlusion.

 

The LAMPOON procedure (Laceration of the Anterior Mitral leaflet to Prevent Outflow ObstructioN) is a transcatheter electrosurgical technique to split the anterior leaflet prior to TMVR. This procedure enables the treatment with TMVR in patients who were previously regarded ineligible based on the risk for LVOT obstruction.

However, the LAMPOON procedure, which is executed via a transseptal approach, is time consuming and technically challenging. Hereby, we present the case of an 81-year-old male who successfully underwent a modified LAMPOON procedure via an apical access prior Tendyne© implantation. This novel approach appears to be time-saving and technically feasible.