Simultaneous Transcatheter Aortic and Mitral Valve-in-Valve Implantation With Edwards Sapien 3 Valves Using LAMPOON: A Case Report

Abstract A 76-year-old female with rheumatic heart disease presented with progressive dyspnea 12 years after dual surgical bioprosthetic valve replacement (mitral: 25 mm; aortic: 21 mm). Diagnostic imaging revealed severe stenosis of both prostheses, with a mitral valve area of 0.8 cm 2 and an aortic valve area of 1.06 cm 2 , complicated by a risk of left ventricular outflow tract obstruction (neo-left ventricular outflow tract obstruction area: 110 mm 2 ). Given the high surgical risk, simultaneous transfemoral transcatheter aortic and mitral valve-in-valve implantation was performed using Edwards Sapien 3 valves. The Laceration of the Anterior Mitral leaflet to Prevent left ventricular Outflow Obstruction (LAMPOON) technique was employed to prophylactically divide the anterior bioprosthetic leaflet, preventing left ventricular outflow tract obstruction. Post-procedural recovery was uncomplicated, and echocardiography demonstrated restored valve function; the mitral mean gradient was 3 mmHg and the aortic mean gradient was 10 mmHg. This case demonstrates the feasibility of dual valve-in-valve therapy for patients with complex bioprosthetic degeneration.