Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement

Journal article

Publication Details

Author(s): Yoon SH, Bleiziffer S, Latib A, Eschenbach L, Ancona M, Vincent F, Kim WK, Unbehaum A, Asarni M, Dhoble A, Silaschi M, Frangieh AH, Veulemans V, Tang GHL, Kuwata S, Rampat R, Schmidt T, Patel AJ, Gomez Nicz PF, Nombela-Franco L, Kini A, Kitamura M, Sharma R, Chakravarty T, Hildick-Smith D, Arnold M, De Brito FS, Jensen C, Jung C, Jilaihawi H, Smalling RW, Maisano F, Kasel AM, Treede H, Kempfert J, Pilgrim T, Kar S, Bapat V, Whisenant BK, Van Belle E, Delgado V, Modine T, Bax JJ, Makkar RR
Journal: Jacc-Cardiovascular Interventions
Publication year: 2019
Volume: 12
Journal issue: 2
Pages range: 182-193
ISSN: 1936-8798


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.

External institutions with authors

Asklepios Klinik Altona
Cedars-Sinai Medical Center
Columbia University
Deutsches Herzzentrum Berlin
Elisabeth-Krankenhaus Essen
EMO GVM Centro Cuore Columbus
Hospital Clínico San Carlos
Hospital São Camilo
Icahn School of Medicine at Mount Sinai
Inselspital, Universitätsspital Bern
Intermountain Healthcare
Leiden University
LILLE 1 University - Science and Technology
Martin-Luther-Universität Halle-Wittenberg (MLU)
Mount Sinai Hospital
New York University (NYU)
Technische Universität München (TUM)
Universitätsklinikum Düsseldorf
Universitätsspital Zürich (USZ)
University of São Paulo / Universidade de São Paulo (USP)
University of Sussex
University of Texas Health Science Center at Houston (UTHealth)

How to cite

Yoon, S.-H., Bleiziffer, S., Latib, A., Eschenbach, L., Ancona, M., Vincent, F.,... Makkar, R.R. (2019). Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement. Jacc-Cardiovascular Interventions, 12(2), 182-193.

Yoon, Sung-Han, et al. "Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement." Jacc-Cardiovascular Interventions 12.2 (2019): 182-193.


Last updated on 2019-16-07 at 08:38