Left ventricular outflow tract obstruction in transcatheter mitral interventions: percutaneous anterior leaflet modification.

Left ventricular outflow tract obstruction (LVOTO) is a catastrophic complication of transcatheter mitral valve replacement, occurring in 0%–40% of procedures and linked to up to 36% mortality.

• Why it matters: LVOTO limits access to TMVR by excluding 4%–50% of candidates and remains a leading cause of patient ineligibility, making accurate risk stratification critical.
• What they did: The review describes cardiac computed tomography–based planning, including virtual valve implantation and neo–left ventricular outflow tract area quantification, and summarizes anterior leaflet modification options such as LAMPOON/ELASTA and balloon-assisted translocation techniques (BATMAN, CLEVE, DETROIT, ROBIN).
• The result: By mapping key anatomic determinants and matching them to complementary anterior leaflet modification strategies, the review supports individualized technique selection to mitigate LVOTO risk and broaden eligibility.

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