Journal article
Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement.
- Yoon SH Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Bleiziffer S 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.
- Latib A Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy.
- Eschenbach L 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.
- Ancona M Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy.
- Vincent F Department of Cardiology/Cardiac Surgery, CHU Lille, Inserm, U1011, University of Lille, Lille, France.
- Kim WK Kerckhoff Heart and Thorax Center, Department of Cardiology/Cardiac Surgery, Bad Nauheim, Germany.
- Unbehaum A Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany.
- Asami M Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Dhoble A Department of Cardiology, University of Texas Health Science Center, Houston, Texas.
- Silaschi M Department of Cardiac Surgery, University of Halle, Halle, Germany.
- Frangieh AH Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
- Veulemans V Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany.
- Tang GHL Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York.
- Kuwata S University Heart Center, University Hospital Zurich, Zurich, Switzerland.
- Rampat R Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
- Schmidt T Department of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany.
- Patel AJ Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
- Nicz PFG Department of Cardiology, Hospital Sao Camilo, Sao Paulo, Brazil.
- Nombela-Franco L Division of Cardiology, Hospital Clinicio San Carlos, Madrid, Spain.
- Kini A Division of Cardiology, Mount Sinai Medical Center, New York, New York.
- Kitamura M Department of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany.
- Sharma R Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Chakravarty T Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Hildick-Smith D Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
- Arnold M Department of Cardiology, University Hospital Erlangen, Erlangen, Germany.
- de Brito FS Heart Institute of University of Sao Paulo Medical School, Sao Paulo, Brazil.
- Jensen C Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen, Essen, Germany.
- Jung C Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany.
- Jilaihawi H Department of Cardiology and Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York.
- Smalling RW Department of Cardiology, University of Texas Health Science Center, Houston, Texas.
- Maisano F University Heart Center, University Hospital Zurich, Zurich, Switzerland.
- Kasel AM Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
- Treede H Department of Cardiac Surgery, University of Halle, Halle, Germany.
- Kempfert J Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany.
- Pilgrim T Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Kar S Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Bapat V Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
- Whisenant BK Division of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, Utah.
- Van Belle E Department of Cardiology/Cardiac Surgery, CHU Lille, Inserm, U1011, University of Lille, Lille, France.
- Delgado V Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
- Modine T Department of Cardiology/Cardiac Surgery, CHU Lille, Inserm, U1011, University of Lille, Lille, France.
- Bax JJ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
- Makkar RR Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: raj.makkar@cshs.org.
- 2019-01-26
Published in:
- JACC. Cardiovascular interventions. - 2019
annuloplasty ring
degenerated bioprosthesis
left ventricular outflow tract obstruction
mitral annular calcification
mitral valve
transcatheter valve implantation
Aged
Aged, 80 and over
Calcinosis
Cardiac Catheterization
Echocardiography
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Male
Mitral Valve
Mitral Valve Insufficiency
Mitral Valve Stenosis
Multidetector Computed Tomography
Prosthesis Design
Prosthesis Failure
Registries
Risk Assessment
Risk Factors
Treatment Outcome
Ventricular Outflow Obstruction
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jcin.2018.12.001
- PMID 30678797
- Persistent URL
- https://sonar.ch/global/documents/293024
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