Why the study?
LVOT obstruction is a common complication of TMVR that can cause hemodynamic impairment and death, motivating a better understanding of its biomechanical implications during valve-in-valve procedures.
Does pre-operative computational modeling of TMVR in a failed bioprosthesis help predict neo-LVOT area and biomechanical stresses?
Does pre-operative computational modeling of TMVR in a failed bioprosthesis help predict neo-LVOT area and biomechanical stresses?
Pre-operative computational modeling of TMVR in failed bioprostheses can assess neo-LVOT area and biomechanical stresses, potentially aiding in optimal THV sizing and preventing LVOT obstruction.
Obstruction of the left ventricular outflow tract (LVOT) is a common complication of transcatheter mitral valve replacement (TMVR). This procedure can determine an elongation of an LVOT (namely, the neo-LVOT), ultimately portending hemodynamic impairment and patient death. This study aimed to understand the biomechanical implications of LVOT obstruction in a patient who underwent TMVR using a transcatheter heart valve (THV) to repair a failed bioprosthetic heart valve. We first reconstructed the heart anatomy and the bioprosthetic heart valve to virtually implant a computer-aided-design (CAD) model of THV and evaluate the neo-LVOT area. A numerical simulation of THV deployment was then developed to assess the anchorage of the THV to the bioprosthetic heart valve as well as the resulting Von Mises stress at the mitral annulus and the contract pressure among implanted bioprostheses. Quantification of neo-LVOT and THV deployment may facilitate more accurate predictions of the LVOT obstruction in TMVR and help clinicians in the optimal choice of the THV size.
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Pasta et al. (2020) studied this question.
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