Accuracy of Three-Dimensional Neo Left Ventricular Outflow Tract Simulations With Transcatheter Mitral Valve Replacement in Different Mitral Phenotypes

Catheter Cardiovasc Interv. 2025 Jan;105(1):249-257. doi: 10.1002/ccd.31287. Epub 2024 Nov 6.

Abstract

Background: Transcatheter mitral valve replacement (TMVR) is emerging in the context of annular calcification (valve-in-MAC; ViMAC), failing surgical mitral annuloplasty (mitral-valve-in-ring; MViR) and failing mitral bioprosthesis (mitral-valve-in-valve; MViV). A notorious risk of TMVR is neo left ventricular outflow tract (neo-LVOT) obstruction. Three-dimensional computational models (3DCM) are derived from multi-slice computed tomography (MSCT) and aim to predict neo-LVOT area after TMVR. Little is known about the accuracy of these neo-LVOT predictions for various mitral phenotypes.

Methods: Preprocedural 3DCMs were created for ViMAC, MViR and MViV cases. Throughout the cardiac cycle, neo-LVOT dimensions were semi-automatically calculated on the 3DCMs. We compared the predicted neo-LVOT area on the preprocedural 3DCM with the actual neo-LVOT as measured on the post-procedural MSCT.

Results: Across 12 TMVR cases and examining 20%-70% of the cardiac phase, the mean difference between predicted and post-TMVR neo-LVOT area was -23 ± 28 mm2 for MViR, -21 ± 34 mm2 for MViV and -73 ± 61 mm2 for ViMAC. The mean intra-class correlation coefficient for absolute agreement between predicted and post-procedural neo-LVOT area (throughout the whole cardiac cycle) was 0.89 (95% CI 0.82-0.94, p < 0.001) for MViR, 0.81 (95% CI 0.62-0.89, p < 0.001) for MViV, and 0.41 (95% CI 0.12-0.58, p = 0.002) for ViMAC.

Conclusions: Three-dimensional computational models accurately predict neo-LVOT dimensions post TMVR in MViR and MViV but not in ViMAC. Further research should incorporate device host interactions and the effect of changing hemodynamics in these simulations to enhance accuracy in all mitral phenotypes.

Keywords: computational modeling; left ventricular outflow tract obstruction; multi‐slice computed tomography; transcatheter mitral valve replacement.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bioprosthesis
  • Cardiac Catheterization* / adverse effects
  • Cardiac Catheterization* / instrumentation
  • Female
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis*
  • Hemodynamics*
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery
  • Mitral Valve* / diagnostic imaging
  • Mitral Valve* / physiopathology
  • Mitral Valve* / surgery
  • Models, Cardiovascular*
  • Multidetector Computed Tomography*
  • Patient-Specific Modeling*
  • Phenotype*
  • Predictive Value of Tests*
  • Prosthesis Design*
  • Radiographic Image Interpretation, Computer-Assisted
  • Reproducibility of Results
  • Treatment Outcome
  • Ventricular Function, Left
  • Ventricular Outflow Obstruction* / diagnostic imaging
  • Ventricular Outflow Obstruction* / etiology
  • Ventricular Outflow Obstruction* / physiopathology
  • Ventricular Outflow Obstruction* / surgery