Validating a prediction modeling tool for left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR)

Authors

Dee Dee Wang, Henry Ford HealthFollow
Marvin H. Eng, Henry Ford HealthFollow
Adam Greenbaum, Henry Ford Health
Eric Myers, Henry Ford HealthFollow
Michael Forbes, Henry Ford Health
Patrick Karabon, Henry Ford Health
Milan Pantelic, Henry Ford HealthFollow
Thomas Song, Henry Ford HealthFollow
Jeffrey Nadig, Henry Ford HealthFollow
Mayra Guerrero
William W. O'Neill, Henry Ford HealthFollow

Recommended Citation

Wang DD, Eng MH, Greenbaum AB, Myers E, Forbes M, Karabon P, Pantelic M, Song T, Nadig J, Guerrero M, and O'Neill WW. Validating a prediction modeling tool for left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR). Catheter Cardiovasc Interv 2018 Aug 1;92(2):379-387.

Document Type

Article

Publication Date

8-1-2018

Publication Title

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

Abstract

OBJECTIVE: Demonstrate proof-of-concept validation of a computed tomography (CT) computer-aided design prediction modeling tool to identify patients at risk for left ventricular outflow tract (LVOT) obstruction in transcatheter mitral valve replacement (TMVR).

BACKGROUND: LVOT obstruction is a significant and even fatal consequence of TMVR.

METHODS: From August 2013 to August 2017, 38 patients in 5 centers underwent TMVR with compassionate use of balloon-expandable valves for severe mitral valve dysfunction because of degenerative surgical mitral ring, bioprosthesis, or severe native mitral stenosis from to severe mitral annular calcification. All patients had preprocedural CT scans performed for anatomic screening, intraprocedural TEE and invasive hemodynamics performed. Preprocedural prediction modeling was performed utilizing computer-aided design (CAD) of the neo-LVOT post-TMVR. Post-TMVR CT scans were obtained and compared to pre-TMVR LVOT modeling datasets for validation.

RESULTS: All patients underwent successful TMVR without device embolization. Seven of the 38 patients experienced LVOT obstruction, defined as an increase of ≥10 mmHg LVOT peak gradient post-TMVR. Anatomic screening using CT was validated in 20/38 patients as preprocedural predicted neo-LVOT surface area correlated well with post-TMVR measurements (R2  = 0.8169, P < 0.0001). A receiver operating curve curve found a predicted neo-LVOT surface area of ≤ 189.4 mm2 to have 100% sensitivity and 96.8% specificity for predicting TMVR-induced LVOT obstruction.

CONCLUSION: CAD design and CT postprocessing are indispensable tools in predicting LVOT obstruction and necessary for anatomic screening in percutaneous TMVR.

PubMed ID

29226591

Volume

92

Issue

2

First Page

379

Last Page

387