Sung-Han Yoon1, Sabine Bleiziffer2, Azeem Latib3, Lena Eschenbach2, Marco Ancona3, Flavien Vincent4, Won-Keun Kim5, Axel Unbehaum6, Masahiko Asami7, Abhijeet Dhoble8, Miriam Silaschi9, Antonio H Frangieh10, Verena Veulemans11, Gilbert H L Tang12, Shingo Kuwata13, Rajiv Rampat14, Tobias Schmidt15, Amisha J Patel16, Pedro Felipe Gomez Nicz17, Luis Nombela-Franco18, Annapoorna Kini19, Mitsunobu Kitamura15, Rahul Sharma1, Tarun Chakravarty1, David Hildick-Smith14, Martin Arnold20, Fabio Sandoli de Brito21, Christoph Jensen22, Christian Jung11, Hasan Jilaihawi23, Richard W Smalling8, Francesco Maisano13, Albert Markus Kasel10, Hendrik Treede9, Joerg Kempfert6, Thomas Pilgrim7, Saibal Kar1, Vinayak Bapat16, Brian K Whisenant24, Eric Van Belle4, Victoria Delgado25, Thomas Modine4, Jeroen J Bax25, Raj R Makkar26. 1. Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. 2. Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität, Munich, Germany; Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany. 3. Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy. 4. Department of Cardiology/Cardiac Surgery, CHU Lille, Inserm, U1011, University of Lille, Lille, France. 5. Kerckhoff Heart and Thorax Center, Department of Cardiology/Cardiac Surgery, Bad Nauheim, Germany. 6. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany. 7. Department of Cardiology, Bern University Hospital, Bern, Switzerland. 8. Department of Cardiology, University of Texas Health Science Center, Houston, Texas. 9. Department of Cardiac Surgery, University of Halle, Halle, Germany. 10. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. 11. Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany. 12. Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York. 13. University Heart Center, University Hospital Zurich, Zurich, Switzerland. 14. Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom. 15. Department of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany. 16. Columbia University Medical Center/New York Presbyterian Hospital, New York, New York. 17. Department of Cardiology, Hospital Sao Camilo, Sao Paulo, Brazil. 18. Division of Cardiology, Hospital Clinicio San Carlos, Madrid, Spain. 19. Division of Cardiology, Mount Sinai Medical Center, New York, New York. 20. Department of Cardiology, University Hospital Erlangen, Erlangen, Germany. 21. Heart Institute of University of Sao Paulo Medical School, Sao Paulo, Brazil. 22. Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen, Essen, Germany. 23. Department of Cardiology and Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York. 24. Division of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, Utah. 25. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 26. Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: raj.makkar@cshs.org.
Abstract
OBJECTIVES: The aim of this study was to evaluate the predictors of left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR). BACKGROUND: LVOT obstruction is a major concern with TMVR, but limited data exist regarding its predictors and impact on outcomes. METHODS: Patients with pre-procedural multidetector row computed tomography (MDCT) undergoing TMVR for failed mitral bioprosthetic valves (valve-in-valve), annuloplasty rings (valve-in-ring), and mitral annular calcification (valve-in-MAC) were included in this study. Echocardiographic and procedural characteristics were recorded, and comprehensive assessment with MDCT was performed to identify the predictors of LVOT obstruction (defined as an increment of mean LVOT gradient ≥10 mm Hg from baseline). The new LVOT (neo-LVOT) area left after TMVR was estimated by embedding a virtual valve into the mitral annulus on MDCT, simulating the procedure. RESULTS: Among 194 patients with pre-procedural MDCT undergoing TMVR (valve-in-valve, 107 patients; valve-in-ring, 50 patients; valve-in-MAC, 37 patients), LVOT obstruction was observed in 26 patients (13.4%), with a higher rate after valve-in-MAC than valve-in-ring and valve-in-valve (54.1% vs. 8.0% vs. 1.9%; p < 0.001). Patients with LVOT obstruction had significantly higher procedural mortality compared with those without LVOT obstruction (34.6% vs. 2.4%; p < 0.001). Receiver-operating characteristic curve analysis showed that an estimated neo-LVOT area ≤1.7 cm2 predicted LVOT obstruction with sensitivity of 96.2% and specificity of 92.3%. CONCLUSIONS: LVOT obstruction after TMVR was associated with higher procedural mortality. A small estimated neo-LVOT area was significantly associated with LVOT obstruction after TMVR and may help identify patients at high risk for LVOT obstruction.
OBJECTIVES: The aim of this study was to evaluate the predictors of left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR). BACKGROUND:LVOT obstruction is a major concern with TMVR, but limited data exist regarding its predictors and impact on outcomes. METHODS:Patients with pre-procedural multidetector row computed tomography (MDCT) undergoing TMVR for failed mitral bioprosthetic valves (valve-in-valve), annuloplasty rings (valve-in-ring), and mitral annular calcification (valve-in-MAC) were included in this study. Echocardiographic and procedural characteristics were recorded, and comprehensive assessment with MDCT was performed to identify the predictors of LVOT obstruction (defined as an increment of mean LVOT gradient ≥10 mm Hg from baseline). The new LVOT (neo-LVOT) area left after TMVR was estimated by embedding a virtual valve into the mitral annulus on MDCT, simulating the procedure. RESULTS: Among 194 patients with pre-procedural MDCT undergoing TMVR (valve-in-valve, 107 patients; valve-in-ring, 50 patients; valve-in-MAC, 37 patients), LVOT obstruction was observed in 26 patients (13.4%), with a higher rate after valve-in-MAC than valve-in-ring and valve-in-valve (54.1% vs. 8.0% vs. 1.9%; p < 0.001). Patients with LVOT obstruction had significantly higher procedural mortality compared with those without LVOT obstruction (34.6% vs. 2.4%; p < 0.001). Receiver-operating characteristic curve analysis showed that an estimated neo-LVOT area ≤1.7 cm2 predicted LVOT obstruction with sensitivity of 96.2% and specificity of 92.3%. CONCLUSIONS:LVOT obstruction after TMVR was associated with higher procedural mortality. A small estimated neo-LVOT area was significantly associated with LVOT obstruction after TMVR and may help identify patients at high risk for LVOT obstruction.
Authors: Jaffar M Khan; Vasilis C Babaliaros; Adam B Greenbaum; Jason R Foerst; Shahram Yazdani; James M McCabe; Gaetano Paone; Marvin H Eng; Bradley G Leshnower; Patrick T Gleason; Marcus Y Chen; Dee Dee Wang; Xin Tian; Annette M Stine; Toby Rogers; Robert J Lederman Journal: J Am Coll Cardiol Date: 2019-05-28 Impact factor: 24.094
Authors: Adam S Evans; Menachem M Weiner; Shahzad Shaefi; Prakash A Patel; Matthew M Townsley; Abirami Kumaresan; Jared W Feinman; Ashley V Fritz; Archer K Martin; Toby B Steinberg; J Ross Renew; Jane L Gui; Brian Radvansky; Himani Bhatt; Sudhakar Subramani; Archit Sharma; Jacob T Gutsche; John G Augoustides; Harish Ramakrishna Journal: J Cardiothorac Vasc Anesth Date: 2019-11-09 Impact factor: 2.628
Authors: John C Lisko; Vasilis C Babaliaros; Jaffar M Khan; Norihiko Kamioka; Patrick T Gleason; Gaetano Paone; Isida Byku; Jasleen Tiwana; James M McCabe; Krishna Cherukuri; Ramzi Khalil; David Lasorda; Sachin S Goel; Neal S Kleiman; Michael J Reardon; David V Daniels; Christian Spies; Paul Mahoney; Brian C Case; Brian K Whisenant; Pradeep K Yadav; Jose F Condado; Rachel Koch; Kendra J Grubb; Christopher G Bruce; Toby Rogers; Robert J Lederman; Adam B Greenbaum Journal: JACC Cardiovasc Interv Date: 2021-03-01 Impact factor: 11.195
Authors: Isaac Wamala; Axel Unbehaun; Christoph Klein; Marian Kukucka; Dirk Eggert-Doktor; Semih Buz; Julia Stein; Simon Sündermann; Volkmar Falk; Jörg Kempfert Journal: Interact Cardiovasc Thorac Surg Date: 2021-05-10