Accuracy of three-dimensional computational modeling in prediction of the dynamic neo left ventricular outflow tract with transcatheter mitral valve replacement. (1st August 2021)

• Record Type: Journal Article
• Authors: Ooms, Joris F.; Ceusters, Joni; Hirsch, Alexander; Budde, Ricardo P.J.; Van Mieghem, Nicolas M.
• Is Part Of: International journal of cardiology. Volume 336(2021)
• Page Start: 93
• Page End: 96
• Publication Date: 2021-08-01
• Subjects: TMVR -- neo-LVOT -- Computational modeling; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.05.002
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Transcatheter mitral valve replacement (TMVR) offers a valuable treatment option for inoperable patients suffering from a degenerated mitral valve after previous ring annuloplasty. Dynamic obstruction of the left ventricular outflow tract(LVOT) is a procedural risk with detrimental consequences and can be estimated upfront using a multi-slice computed tomography(MSCT) derived 3D computational model(3DCM). This study explored the accuracy of pre-procedural neo-LVOT prediction in TMVR using 3DCMs of multiple cardiac phases. Methods: We obtained both pre- and post-procedural MSCT scans of a patient who underwent uncomplicated TMVR and derived 3DCMs from each cardiac phase. Virtual implantations of the deployed valve were performed and neo-LVOT dimensions were semi-automatically calculated in the pre-procedural models and matched with the post-procedural models. Predicted and post-procedural neo-LVOTs were compared between 3DCMs. Results: From cardiac phases 20–70%, 11 matched 3DCM pairs were generated. The mean difference between predicted and post-TMVR neo-LVOT area was 3 ± 23 mm 2 . The intra-class correlation coefficient for absolute agreement between predicted and post-procedural neo-LVOT area was 0.86 (95%CI 0.56–0.96, p < 0.001). Conclusion: 3DCMs could accurately predict post-TMVR neo-LVOT dimensions in a patient with a pre-existing mitral annular ring. Prospective research is warranted to demonstrate the accuracy of these models in larger samples and different mitral annular phenotypes. Highlights: Dynamic LVOT obstruction is a notorious risk of TMVR. A CT-derived 3D computational model(3DCM) might aid in procedural risk assessment. The accuracy of multi-phase LVOT prediction post-TMVR using 3DCMs was examined. 3DCMs could accurately predict post-TMVR neo LVOT dimensions, however prospective research is required.