ArticleJACC. Case reports2026
Mavacamten Reduces LVOT Obstruction Risk, Enabling Transseptal Mitral Valve-in-Valve for Degenerated Bioprosthesis.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundTranscatheter mitral valve replacement (TMVR) is an alternative to redo surgery for failed mitral bioprostheses, but left ventricular outflow tract (LVOT) obstruction remains a major limitation. CASE SUMMARY: An 86-year-old woman presented with heart failure due to severe prosthetic mitral restenosis. Screening computed tomography (CT) predicted a critically small neo-LVOT, rendering TMVR prohibitive. Given prohibitive surgical risk and no feasible LVOT obstruction-mitigation procedure, off-label mavacamten 2.5 mg daily was initiated. After 4 months, repeat CT showed neo-LVOT enlargement, enabling transseptal valve-in-valve TMVR without complications. Invasive hemodynamics excluded a relevant LVOT gradient; echocardiography confirmed excellent valve function without LVOT obstruction. WHY BEYOND THE GUIDELINES: No guideline-endorsed pharmacologic strategy exists to enlarge predicted neo-LVOT before TMVR. DISCUSSION: Myosin inhibition may offer a noninvasive LVOT obstruction-mitigation bridge when procedural options are unsuitable. TAKE-HOME MESSAGE: In selected patients with prohibitive neo-LVOT, short-term mavacamten may convert CT screening to a feasible TMVR pathway.
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