Neo-LVOT and Transcatheter Mitral Valve Replacement

Reid, Anna; Zekry, Sagit Ben; Turaga, Mansi; Tarazi, Stephanie; Bax, Jeroen J.; Wang, Dee Dee; Piazza, Nicolò; Bapat, Vinayak; Ihdayhid, Abdul Rahman; Cavalcante, João L.; Blanke, Philipp; Leipsic, Jonathon

doi:10.1016/j.jcmg.2020.09.027

Cited by 73 publications

(50 citation statements)

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“…To date, several transcatheter MV intervention devices have been developed and applied into clinical practice for patients with symptomatic severe MR. In TMVR and direct transcatheter mitral annuloplasty, accurate assessment of 3D MA geometry is becoming important for device size selection and procedural success without complications [ 18 , 19 , 20 ]. Various articles reported on the utility of 3D MDCT assessment for procedural planning of transcatheter MV intervention [ 7 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Annulus Dimensions Assessment with Three-Dimensional Echocardiography Versus Computed Tomography: Implications for Transcatheter Interventions

Hirasawa

Gegenava

et al. 2021

JCM

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The aim of this study is to evaluate the agreement between three-dimensional (3D) transesophageal echocardiography (TEE) and multidetector computed tomography (MDCT) for assessing mitral annular (MA) dimensions. A total of 105 patients (79 ± 9 years old, 52% male) who underwent clinically indicated 3D TEE and MDCT feasible for MA geometrical assessment were included. Using dedicated semi-automated postprocessing software, MA geometry, including mitral annular area (MAA), perimeter, septal-lateral (SL) diameter, and inter-trigonal (TT) diameter, was evaluated using 3D TEE and MDCT. Compared to 3D TEE, MAA, perimeter, and SL distance measured on MDCT data were larger (9.9 ± 3.0 vs. 9.3 ± 3.1 cm2 for MAA; 115 ± 18 vs. 108 ± 18 mm for perimeter; and 35 ± 5 vs. 32 ± 5 cm for SL distance, all p < 0.001). By contrast, the TT distance was comparable between MDCT and 3D TEE (26 ± 4 vs. 26 ± 4 cm, p = 0.258). The correlations of all the MA dimensions were good to excellent between the two modalities (R = 0.911 for MAA, 0.890 for perimeter, 0.739 for TT distance, and 0.857 for SL distance, respectively, all p < 0.001). This study showed good agreement between 3D TEE- and MDCT-derived MA measurements although MDCT systematically provided larger MAA, perimeter, and SL distance compared with 3D TEE.

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Section: Discussionmentioning

confidence: 99%

Mitral Valve Annulus Dimensions Assessment with Three-Dimensional Echocardiography Versus Computed Tomography: Implications for Transcatheter Interventions

Hirasawa

Gegenava

et al. 2021

JCM

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“…LVOTO can occur because a narrow neo-LVOT may be created between the stent of the prosthesis and the septum of the left ventricle. Apart from this fixed narrowing, a dynamic component resulting from SAM of the AML may occur and cause or aggravate LVOTO ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…To avoid the introduction of a narrow neo-LVOT, preprocedural planning includes cardiac CT with virtual implantation of the intended valve prosthesis and calculation of the systolic area of the projected neo-LVOT ( 4 ). Apart from anatomical factors, such as the aortomitral angle, the presence of a “septal bulge,” and the size and profile of the prosthesis to be implanted, the risk of LVOTO is also related to the properties of the AML.…”

Section: Discussionmentioning

confidence: 99%

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Left Ventricular Outflow Tract Obstruction Following Transcatheter Mitral Valve Replacement Resolved by Chordal Rupture

et al. 2021

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“…Cardiac CT provides valuable information, including prosthesis dimensions and predicting the risk of left ventricular outflow tract (LVOT) obstruction. The risk of LVOT obstruction was assessed preoperatively by mean of virtual valve implant of the desired device using dedicated software and measuring the residual neo-LVOT (Circle cvi42, Circle Cardiovascular Imaging Inc., Calgary, AB, Canada) (14,15). TA MVIV through mini left anterolateral thoracotomy was the only approach until 2016, where the TF access with transseptal puncture became the preferred access thereafter.…”

Section: Population and Patient Selectionmentioning

confidence: 99%

Access options for transcatheter mitral valve implantation in patients with prior surgical bioprosthesis

Besola¹,

Cheung²,

Ye³

et al. 2021

Ann Cardiothorac Surg

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Background: Transcatheter mitral valve-in-valve (TMVIV) procedure, either transapical (TA) or trans-septal (TS) has become a valuable alternative to conventional redo surgery in case of failing mitral bioprosthesis with good clinical outcomes. Here we present our fourteen-year institutional experience.Methods: All consecutive patients treated with TMVIV with either TA or TS access at our centre between July 2007 and July 2020 were included. Periprocedural and 30-day follow-up (FU) results are reported and TA and TS data are compared.Results: Eighty-two patients were included, of those 60 (73.2%) were TA while 22 (26.8%) were TS.Men represented 51.2% of the population with a mean age of 77.3±9.0 years. STS score and EuroSCORE II were 11.4%±6.2% and 11.5%±6.5% respectively. Baseline characteristics of TA and TS groups were comparable. TMVIV was performed at a median time of 9.3 years [interquartile range (IQR), 7.9-12.0 days] from the initial mitral valve surgery. Balloon expandable transcatheter heart valve (THV) prostheses (Edwards LifeSciences Corp., Irvine, CA, USA) were used exclusively. Technical success was 97.6% (96.7% and 100.0% for TA and TS respectively) with two (2.4%) periprocedural death, both in the TA group (P=0.533). We observed four (4.9%) left ventricular outflow tract (LVOT) obstructions with one being hemodynamically significant. Six (7.3%) major bleeding occurred in the TA group, not significantly different from TS group (P=0.279). The median length of stay was 6 days (IQR, 4-12 days, 1.5 vs. 7.0 days for TS and TA groups respectively, P=0.001). The overall 30-day mortality rate was 3.7%. We also observed three (3.7%) structural valve deteriorations and in one (1.2%) case the patient required redo mitral surgery at two months.Eighty-seven-point-eight percent of patients were I-II New York Heart Association (NYHA) class. At 30day FU mean transmitral valve gradient was 7.3±2.7 mmHg and one patient (1.2%) had mitral regurgitation greater than mild. TA and TS groups were comparable.Conclusions: Our 14-year single-center experience with TMVIV confirms procedural safety and is an effective alternative to redo surgery with comparable results with both TA and TS. With device, technical improvements and increasing operators' experience, TS is the preferred option for TMVIV. However, in some highly selected patient, TA may still play an important role.

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Neo-LVOT and Transcatheter Mitral Valve Replacement

Cited by 73 publications

References 40 publications

Mitral Valve Annulus Dimensions Assessment with Three-Dimensional Echocardiography Versus Computed Tomography: Implications for Transcatheter Interventions

Mitral Valve Annulus Dimensions Assessment with Three-Dimensional Echocardiography Versus Computed Tomography: Implications for Transcatheter Interventions

Left Ventricular Outflow Tract Obstruction Following Transcatheter Mitral Valve Replacement Resolved by Chordal Rupture

Access options for transcatheter mitral valve implantation in patients with prior surgical bioprosthesis

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