Key result
Larger neo-LVOT area strongly correlates with lower LVOT pressure drops in computational modeling.
Why the study?
TMVR for failed annuloplasty rings, bioprostheses, and mitral annular calcification can cause permanent LVOT obstruction, making neo-LVOT area assessment essential during pre-procedural screening.
Answers are grounded in this paper and cite their sources.
Patient-specific in silico simulations and 3D printed models can accurately predict neo-LVOT area and associated hemodynamic risks during pre-procedural planning for complex TMVR.
The assessment of the neo-left ventricular outflow tract (neo-LVOT) area is an essential metric for pre-procedural imaging when screening patients for transcatheter mitral valve replacement (TMVR) eligibility. Indeed, the implantation of transcatheter heart valves for treating failed annuloplasty band ring (ViR), bioprosthesis (ViV) and mitral valve calcification (ViMAC) can lead to a permanent obstruction of the implanted device (namely, LVOT obstruction). In this study, in silico computational modeling and 3D printing were used to quantify the neo-LVOT area and the resulting hemodynamic outcomes of TMVR. We first simulated the deployment of the SAPIEN 3 Ultra device (Edwards Lifesciences, Irvine, CA) and then evaluated the pressure drop near the LVOT obstruction using computational fluid dynamics. The neo-LVOT area was largest in patients with ViR (453.4 ± 58.1 mm2) compared to patients with ViV (246.6 ± 109.5 mm2) and ViMAC (155.6 ± 46.1 mm2). The pressure drop near the LVOT obstruction differed among patients with TMVRs and significantly correlated with the magnitude of the neo-LVOT area (R = −0.761 and P-value = 0.047). The present study highlights the potential of in silico and 3D printed models for planning TMVR procedures and for carrying out a risk evaluation of the device protrusion into the left heart when treating failed mitral valves.
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Catalano et al. (2023) studied Failed mitral valve annuloplasty ring, bioprosthesis, or severe calcification (n=7). SAPIEN 3 Ultra device deployment in failed mitral valves was evaluated on Correlation between neo-LVOT area and pressure drop near the obstruction (R = -0.761, p=0.047). The pressure drop near the LVOT obstruction significantly correlated with the magnitude of the neo-LVOT area (R = -0.761, P=0.047), which was largest in patients with ViR (453.4 sq mm).
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