Transcatheter Mitral Valve Profile Impacts Left Ventricular Outflow Tract Hemodynamics: An In Silico Study
Keshav Kohli1, Yinghan Xu1, Zhenglun Alan Wei1, Tiffany Netto1, Adam Greenbaum2, Vasilis Babaliaros2, Philipp Blanke3, John Oshinski2, Ajit Yoganathan1.
1Georgia Institute of Technology, Atlanta, GA, USA, 2Emory University, Atlanta, GA, USA, 3St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada.
OBJECTIVE: Device profile may affect the risk of left ventricular outflow tract (LVOT) obstruction in transcatheter mitral valve replacement (TMVR). The objective of this study was to compare the risk of LVOT obstruction in patients screened for a TMVR procedure with the TendyneTM system using two available device profiles: the standard-profile device and low-profile device.
METHODS: Baseline computed tomography (CT) scans were analyzed in four patients who failed screening for TendyneTM implantation due to a high anticipated risk of LVOT obstruction with the standard-profile device. In these subjects, a validated CT-based computational fluid dynamics method was used to simulate valve implantation and hemodynamics with both the standard-profile and low-profile TendyneTM devices. The risk of LVOT obstruction was assessed by calculating the peak LVOT pressure gradient. A gradient of ≥ 30 mmHg was considered to be clinically significant.
RESULTS: Flow simulations qualitatively demonstrated a reduction in outflow velocity and widening of the outflow jet with the low-profile device as compared to the standard-profile device (Figure 1A). Across all patients, there was a 57± 33% reduction in peak LVOT gradient with the low-profile device. While simulated LVOT gradients were all ≥ 30 mmHg with the standard-profile device, the low-profile device successfully decreased these gradients to <30 mmHg in all patients (Figure 1B).
CONCLUSIONS: Flow simulations demonstrate that lower-profile devices have the potential to improve hemodynamics and reduce the risk of LVOT obstruction following TMVR as compared to standard-profile devices. Further development of such low-profile devices may ultimately lead to increased patient eligibility for the TMVR procedure.
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