What is the clinical evidence from this study?

Study design: Systematic Review. Population: Postoperative transient left ventricular outflow tract obstruction (LVOTO) (n=58). Intervention: Mitral valve surgery (surgical or transcatheter). Primary outcome: Anatomical and geometric characteristics associated with LVOTO.

What does this research mean for the field?

Postoperative transient left ventricular outflow tract obstruction after mitral valve surgery is primarily driven by systolic anterior motion and anatomical factors including an elongated anterior leaflet, narrow aorto-mitral angle, and basal septal hypertrophy. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the anatomical, geometric, and hemodynamic mechanisms, predisposing risk factors, and clinical management strategies for transient left ventricular outflow tract obstruction following mitral valve interventions.

October 1, 2026Turkish Journal of Thoracic and Cardiovascular SurgeryOpen Access

Postoperative transient left ventricular outflow tract obstruction after mitral valve surgery: A systematic review of anatomical and hemodynamic factors

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Key result

Post-mitral surgery LVOTO is linked to elongated anterior leaflets, narrow LVOT geometry, and SAM.

n=58

Why the study?

Evidence regarding the mechanisms, predisposing factors, and management of postoperative LVOTO following mitral valve surgery remains limited.

Design

Systematic review of observational studies, case series, and case reports

Authors

KKKristian KurniawanAtma Jaya Catholic University of Indonesia AHArinto Bono Adji HardjosworoPelita Harapan University BHBagus HerlambangPelita Harapan University

Discussion

Member takes

Implication

Preoperative geometric assessment may guide mitral valve surgical planning to reduce LVOTO risk; extends case reports but leaves optimal prevention strategies open for prospective study.

Key Points

To evaluate the anatomical, geometric, and hemodynamic mechanisms, predisposing risk factors, and clinical management strategies for transient left ventricular outflow tract obstruction following mitral valve interventions.
Conducted a PRISMA-compliant systematic review registered in PROSPERO (CRD420251127617) searching PubMed, Embase, CENTRAL, Google Scholar, and ProQuest through July 2025.
Identified 30 eligible studies (28 single-patient case reports, one case series, and one multicenter observational registry) comprising 58 patients with clinically or imaging-confirmed postoperative LVOTO.
Most reported cases occurred in older adults with degenerative or rheumatic mitral disease, including 22 female patients among the 28 single-patient case reports and 105 female participants (54.1%) among 194 patients in the multicenter registry.
Systolic anterior motion was documented in more than two-thirds of cases (and explicitly in 19 of 58 patients, 32.8%), with management ranging from medical therapy to surgical or transcatheter re-intervention yielding generally favorable outcomes.

Study Design

Type

Systematic Review (n=58)

Structured PICO

Population

58 patients from 30 studies (predominantly case reports) who developed transient left ventricular outflow tract obstruction following surgical or transcatheter mitral valve interventions.

Intervention

Surgical or transcatheter mitral valve intervention (including mitral valve repair, mitral valve replacement, transcatheter mitral valve replacement, valve-in-valve, valve-in-ring, and valve-in-mitral-annular-calcification procedures)

Outcome

Anatomical and hemodynamic factors, pathophysiological mechanisms, and management strategies associated with postoperative LVOTO

Postoperative LVOTO after mitral valve surgery is a geometry-driven complication associated with specific anatomical features like an elongated anterior mitral leaflet and small LVOT, highlighting the importance of preprocedural imaging for risk stratification.

Limitations

Evidence base dominated by individual case reports and small case series
Potential for publication and reporting bias
Inconsistent reporting of anatomical characteristics across studies
Lack of comparator groups precludes estimation of independent associations
Predominance of case reports and small case series
Substantial clinical heterogeneity
Potential reporting and publication bias
Absence of comparator groups
Incomplete reporting of anatomical measurements across studies

Cite This Study

Kurniawan et al. (2026) conducted a systematic review in Postoperative transient left ventricular outflow tract obstruction (LVOTO) (n=58). Mitral valve surgery (surgical or transcatheter) was evaluated on Anatomical and geometric characteristics associated with LVOTO. Postoperative LVOTO following mitral valve surgery is a geometry-dependent complication frequently associated with an elongated anterior mitral leaflet, small LVOT, narrow aorto-mitral angle, and systolic anterior motion.

synapsesocial.com/papers/6abda8f14d657f10339f950c https://doi.org/10.4274/tjtcs.2026.2026-4-37

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Implication

Preoperative geometric assessment may guide mitral valve surgical planning to reduce LVOTO risk; extends case reports but leaves optimal prevention strategies open for prospective study.

Postoperative transient left ventricular outflow tract obstruction after mitral valve surgery: A systematic review of anatomical and hemodynamic factors

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Postoperative transient left ventricular outflow tract obstruction after mitral valve surgery: A systematic review of anatomical and hemodynamic factors

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

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