December 11, 2017Catheterization and Cardiovascular Interventions183 citations
View Full PaperValidating a prediction modeling tool for left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR)
Structured PICO
Does a CT computer-aided design prediction modeling tool accurately predict LVOT obstruction in patients undergoing TMVR?
P
Population
38 patients undergoing TMVR with compassionate use of balloon-expandable valves for severe mitral valve dysfunction (degenerative surgical mitral ring, bioprosthesis, or severe native mitral stenosis from severe mitral annular calcification)
I
Intervention
Preprocedural prediction modeling utilizing computer-aided design (CAD) of the neo-LVOT post-TMVR based on CT scans
C
Comparator
Post-TMVR CT scans (used as validation standard)
O
Outcome
Prediction of TMVR-induced LVOT obstructionsurrogate
A CT-based computer-aided design prediction modeling tool demonstrates high sensitivity and specificity for predicting LVOT obstruction in patients undergoing TMVR.
Abstract
OBJECTIVE: Demonstrate proof-of-concept validation of a computed tomography (CT) computer-aided design prediction modeling tool to identify patients at risk for left ventricular outflow tract (LVOT) obstruction in transcatheter mitral valve replacement (TMVR). BACKGROUND: LVOT obstruction is a significant and even fatal consequence of TMVR. METHODS: From August 2013 to August 2017, 38 patients in 5 centers underwent TMVR with compassionate use of balloon-expandable valves for severe mitral valve dysfunction because of degenerative surgical mitral ring, bioprosthesis, or severe native mitral stenosis from to severe mitral annular calcification. All patients had preprocedural CT scans performed for anatomic screening, intraprocedural TEE and invasive hemodynamics performed. Preprocedural prediction modeling was performed utilizing computer-aided design (CAD) of the neo-LVOT post-TMVR. Post-TMVR CT scans were obtained and compared to pre-TMVR LVOT modeling datasets for validation. RESULTS: to have 100% sensitivity and 96.8% specificity for predicting TMVR-induced LVOT obstruction. CONCLUSION: CAD design and CT postprocessing are indispensable tools in predicting LVOT obstruction and necessary for anatomic screening in percutaneous TMVR.