Role of Cardiac CT in Pre-Procedure Planning for Transcatheter Mitral Valve Replacement
| Autor: | Ayaz Aghayev, Ron Blankstein, Yin Ge, Marcelo F. Di Carli, Sunil Gupta, Piotr Sobieszczyk, Deepak L. Bhatt, Michael L. Steigner, Pinak B. Shah, Emilio Fentanes, Tsuyoshi Kaneko |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Cardiac Catheterization
medicine.medical_specialty genetic structures medicine.medical_treatment Context (language use) 030204 cardiovascular system & hematology Ventricular Outflow Obstruction 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Humans Medicine Ventricular outflow tract Radiology Nuclear Medicine and imaging Aged Aged 80 and over Heart Valve Prosthesis Implantation Pre-Procedure Thoracic surgeon business.industry Mortality rate Mitral valve replacement Mean age Middle Aged medicine.disease Surgery Heart Valve Prosthesis Mitral Valve Female sense organs Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Calcification |
| Zdroj: | JACC: Cardiovascular Imaging. 14:1571-1580 |
| ISSN: | 1936-878X |
| Popis: | Objectives This study sought to evaluate cardiac computed tomography (CCT) findings and their clinical impact among patients being considered for transcatheter mitral valve replacement (TMVR). Background CCT is used to evaluate whether patients are candidates for TMVR, but limited data exist on the yield of such tests. Methods Patients referred for pre-procedural CCT for TMVR planning in the context of failing mitral bioprosthetic valves, annuloplasty rings, and severe native valve disease with annular calcification were included in this study. CCT findings were analyzed to evaluate for suitability for TMVR. In the subset of patients who underwent TMVR, echocardiographic and procedural characteristics were recorded. Results Among 80 patients who underwent pre-procedural CCT, the mean age was 71.8 ± 11.4 years, 60% were women, and the mean Society of Thoracic Surgeon score was 9.4 ± 6.7. Most cases were referred for valve-in-native annular calcification planning (n = 43), followed by valve-in-valve (n = 29), and valve-in-ring procedures (n = 8). A total of 51 (64%) patients did not undergo TMVR, 37 of whom had high-risk features identified on CCT. The most common reason for exclusion was related to large annular size, followed by heightened risk of left ventricular outflow tract (LVOT) obstruction. Among 29 patients (36%) who underwent TMVR, the 30-day mortality rate was 17%. Five patients experienced LVOT obstruction, 4 of whom were predicted by CCT. Following TMVR, 5 patients had at least moderate peri-valvular regurgitation. Conclusions A minority of patients referred for TMVR planning ultimately undergo the procedure. CCT identifies unsuitable anatomy and leads to exclusion in a significant number of cases. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|