Author + information
- Buntaro Fujita1,
- Julius Gerstmeyer2,
- Werner Scholtz3,
- Jochen Börgermann4,
- Jan Gummert5 and
- Stephan Ensminger6
Precise positioning of transcatheter heart valves during a mitral valve-in-valve (ViV) procedure is crucial to achieve optimal hemodynamic outcomes whilst avoiding LVOT impairment and potentially obstruction. We report 6 cases of mitral ViV procedures utilizing innovative pre-procedural image analysis including 3D simulation of the procedure.
6 patients who underwent a mitral ViV-procedure with or without concomitant transcatheter aortic valve replacement were investigated. The patients’ 4 heart chambers and ascending aorta were reconstructed based on pre-procedural cardiac CT images with 3matic® and Mimics® (both Materialise, Leuven, Belgium) (Figure 1A). Furthermore, CT images of fully expanded SAPIEN XT valves were obtained and virtually reconstructed.
The SAPIEN XT valves were then virtually implanted into the native cardiac CT images using 3matic® to simulate the procedure (Figure 1B). For different implantation positions, the distance and remaining space between the tip of the SAPIEN XT and free wall of the LVOT were determined using Mimics®. In 5/6 cases, these measurements showed no impairment of the LVOT (<50%). During the actual patient procedures, the THV was implanted exactly as simulated (Figure 1C) with a procedural success and 6-months-survival rate of 100%. However, in 1/6 patients, these simulations showed a 68% narrowing of the LVOT even when the SAPIEN XT valve was implanted as far as possible towards the left atrium. After thorough discussion within the Heart Team this patient was treated with medical therapy only.
Virtual simulation of a mitral ViV-procedure using innovative imaging modalities and 3D reconstruction is feasible and correlated very well with the actual patient procedure. This approach is suitable and represents a cost-effective and non-invasive tool to almost eliminate the risk for LVOT obstruction following mitral ViV-procedures.
STRUCTURAL: Valvular Disease: Mitral