AIMS: The high frequency of screening failure for anatomical reasons in patients with severe mitral valve regurgitation (MR) is a limiting factor in the screening process for transcatheter mitral valve replacement (TMVR). However, data on optimal patient selection are scarce. The present study aimed to develop a screening algorithm based on TMVR screening data. METHODS AND RESULTS: A total of 195 screenings for six different TMVR devices were performed in 94 high-risk patients with severe MR. We compared baseline echocardiographic and multislice computed tomography (MSCT) parameters between the subgroups of patients accepted (N=33) and rejected for TMVR (N=61). Reasons for screening failure were assessed, and a decision tree algorithm was statistically derived. Reasons for screening failure were small LV dimensions (30.6%), small (7.5%) or large (22.5%) annular size, potential risk of LVOT obstruction (22.0%) or mitral annulus calcification (15.6%). A four-step decision tree algorithm to assess TMVR eligibility was developed resulting in an AUC of 0.80 (95% CI: 0.71, 0.89, p<0.0001). CONCLUSIONS: This study presents the first screening algorithm to assess anatomical eligibility for TMVR in patients with severe MR, based on simple MSCT criteria. Given the high rate of TMVR screening failure, this algorithm may facilitate the identification of potential TMVR candidates.
AIMS: The high frequency of screening failure for anatomical reasons in patients with severe mitral valve regurgitation (MR) is a limiting factor in the screening process for transcatheter mitral valve replacement (TMVR). However, data on optimal patient selection are scarce. The present study aimed to develop a screening algorithm based on TMVR screening data. METHODS AND RESULTS: A total of 195 screenings for six different TMVR devices were performed in 94 high-risk patients with severe MR. We compared baseline echocardiographic and multislice computed tomography (MSCT) parameters between the subgroups of patients accepted (N=33) and rejected for TMVR (N=61). Reasons for screening failure were assessed, and a decision tree algorithm was statistically derived. Reasons for screening failure were small LV dimensions (30.6%), small (7.5%) or large (22.5%) annular size, potential risk of LVOT obstruction (22.0%) or mitral annulus calcification (15.6%). A four-step decision tree algorithm to assess TMVR eligibility was developed resulting in an AUC of 0.80 (95% CI: 0.71, 0.89, p<0.0001). CONCLUSIONS: This study presents the first screening algorithm to assess anatomical eligibility for TMVR in patients with severe MR, based on simple MSCT criteria. Given the high rate of TMVR screening failure, this algorithm may facilitate the identification of potential TMVR candidates.
Authors: S Ludwig; D Kalbacher; N Schofer; A Schäfer; B Koell; M Seiffert; J Schirmer; U Schäfer; D Westermann; H Reichenspurner; S Blankenberg; E Lubos; L Conradi Journal: Clin Res Cardiol Date: 2020-10-19 Impact factor: 5.460
Authors: Giulio Russo; Francesco Maisano; Gianluca Massaro; Giuseppe Terlizzese; Enrica Mariano; Michela Bonanni; Andrea Matteucci; Andrea Bezzeccheri; Daniela Benedetto; Gaetano Chiricolo; Eugenio Martuscelli; Giuseppe Massimo Sangiorgi Journal: Front Cardiovasc Med Date: 2022-02-09
Authors: Faizus Sazzad; Jimmy Kim Fatt Hon; Kollengode Ramanathan; Jie Hui Nah; Zhi Xian Ong; Lian Kah Ti; Roger Foo; Edgar Tay; Theo Kofidis Journal: Front Cardiovasc Med Date: 2022-02-24