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Role of Cardiac Computed Tomography in Planning Transcatheter Mitral Valve Replacement (TMVR)

  • Cardiac PET, CT, and MRI (P Cremer, Section Editor)
  • Published:
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Abstract

Purpose of Review

Transcatheter mitral valve replacement (TMVR) is an evolving and rapidly expanding field within structural interventions, offering renewed treatment options for patients with high-risk mitral valve disease. We aim to highlight and illustrate the importance of cardiac CT in the planning of TMVR.

Recent Findings

As TMVR has evolved, so has the specific nuances of cardiac CT planning, we now understand the importance of accurate annular sizing and valve simulation to predict complications such as neo-LVOT obstruction and paravalvular leak (PVL). More so than any other modality, cardiac CT remains instrumental in accurately planning TVMR from feasibility, device sizing, access, and fluoroscopic angles.

Summary

Cardiac CT remains the key modality in TMVR evaluation, often the first step in determining patient eligibility through comprehensive procedural planning as well as informing potential outcomes and prognosis. In this review, we discuss the critical role of cardiac computed tomography (CT) and the specific considerations involved in TMVR.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mack M, Carroll John D, Thourani V, et al. Transcatheter mitral valve therapy in the United States. J Am Coll Cardiol. 2021;78:2326–53.

    Article  Google Scholar 

  2. Little SH, Bapat V, Blanke P, Guerrero M, Rajagopal V, Siegel R. Imaging guidance for transcatheter mitral valve intervention on prosthetic valves, rings, and annular calcification. JACC: Cardiovascular Imaging 2021;14:22–40.

  3. Yoon SH, Whisenant BK, Bleiziffer S, et al. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J. 2019;40:441–51.

    Article  Google Scholar 

  4. Guerrero M, Pursnani A, Narang A et al. Prospective evaluation of transseptal TMVR for failed surgical bioprostheses: MITRAL trial valve-in-valve arm 1-year outcomes. JACC: Cardiovascular Interventions 2021;14:859–72.

  5. Pirelli L, Hong E, Steffen R, Vahl TP, Kodali SK, Bapat V. Mitral valve-in-valve and valve-in-ring: tips, tricks, and outcomes. Annals of cardiothoracic surgery. 2021;10:96–112.

    Article  Google Scholar 

  6. Bapat V, Pirone F, Kapetanakis S, Rajani R, Niederer S. Factors influencing left ventricular outflow tract obstruction following a mitral valve-in-valve or valve-in-ring procedure, part 1. Catheter Cardiovasc Interv. 2015;86:747–60.

    Article  Google Scholar 

  7. Guerrero M, Wang DD, Pursnani A, et al. Prospective evaluation of TMVR for failed surgical annuloplasty rings: MITRAL trial valve-in-ring arm 1-year outcomes. JACC Cardiovasc Interv. 2021;14:846–58.

    Article  Google Scholar 

  8. Urena M, Brochet E, Lecomte M, et al. Clinical and haemodynamic outcomes of balloon-expandable transcatheter mitral valve implantation: a 7-year experience. Eur Heart J. 2018;39:2679–89.

    Article  Google Scholar 

  9. Guerrero M, Wang DD, Pursnani A et al. A cardiac computed tomography-based score to categorize mitral annular calcification severity and predict valve embolization. JACC: Cardiovascular Imaging 2020;13:1945–57.

  10. • Pulerwitz TC, Khalique OK, Leb J et al. Optimizing cardiac CT protocols for comprehensive acquisition prior to percutaneous MV and TV repair/replacement. JACC: Cardiovascular Imaging 2020;13:836–50. This paper is a thorough review on how to optimize CT protocol for adequate image quality and preprocedural planning.

  11. Guerrero M, Urena M, Himbert D, et al. 1-year outcomes of transcatheter mitral valve replacement in patients with severe mitral annular calcification. J Am Coll Cardiol. 2018;71:1841–53.

    Article  Google Scholar 

  12. Sorajja P, Moat N, Badhwar V, et al. Initial feasibility study of a new transcatheter mitral prosthesis. J Am Coll Cardiol. 2019;73:1250–60.

    Article  Google Scholar 

  13. Muller DWM, Farivar RS, Jansz P, et al. Transcatheter mitral valve replacement for patients with symptomatic mitral regurgitation: a global feasibility trial. J Am Coll Cardiol. 2017;69:381–91.

    Article  Google Scholar 

  14. Perpetua EM, Reisman M. The Tendyne transcatheter mitral valve implantation system. EuroIntervention 17;11:W78-W79.

  15. Muller DW, Sorajja P, Duncan A, Bethea B, Dahle G, Grayburn P, et al. 2-year outcomes of transcatheter mitral valve replacement in patients with severe symptomatic mitral regurgitation. J Am Coll Cardiol 2021;78:1847–59.

  16. Dahle G. Current devices in TMVI and their limitations: focus on Tendyne. Frontiers in Cardiovascular Medicine 2020;7.

  17. Ge Y, Gupta S, Fentanes E et al. Role of cardiac CT in pre-procedure planning for transcatheter mitral valve replacement. JACC: Cardiovascular Imaging 2021;14:1571–80.

  18. Ranganath P, Moore A, Guerrero M, et al. CT for pre- and postprocedural evaluation of transcatheter mitral valve replacement. Radiographics. 2020;40:1528–53.

    Article  Google Scholar 

  19. Morris MF, Pena A, Kalya A, et al. Predicting paravalvular leak after transcatheter mitral valve replacement using commercially available software modeling. J Cardiovasc Comput Tomogr. 2020;14:495–9.

    Article  Google Scholar 

  20. Krishnaswamy A, Kapadia SR. Indirect mitral annuloplasty using the Carillon device. Front Cardiovasc Med. 2020;7: 576058.

    Article  Google Scholar 

  21. Natarajan N, Patel P, Bartel T, et al. Peri-procedural imaging for transcatheter mitral valve replacement. Cardiovascular Diagnosis and Therapy. 2016;6:144–59.

    Article  Google Scholar 

  22. Blanke P, Dvir D, Cheung A, et al. A simplified D-shaped model of the mitral annulus to facilitate CT-based sizing before transcatheter mitral valve implantation. J Cardiovasc Comput Tomogr. 2014;8:459–67.

    Article  Google Scholar 

  23. Garcia-Sayan E, Chen T, Khalique OK. Multimodality cardiac imaging for procedural planning and guidance of transcatheter mitral valve replacement and mitral paravalvular leak closure. Frontiers in Cardiovascular Medicine 2021;8.

  24. Blanke P, Naoum C, Webb J et al. Multimodality imaging in the context of transcatheter mitral valve replacement: establishing consensus among modalities and disciplines. JACC: Cardiovascular Imaging 2015;8:1191–1208.

  25. Yoon S-H, Bleiziffer S, Latib A et al. Predictors of left ventricular outflow tract obstruction after transcatheter mitral valve replacement. JACC: Cardiovascular Interventions 2019;12:182–93.

  26. Blanke P, Naoum C, Dvir D et al. Predicting LVOT obstruction in transcatheter mitral valve implantation. JACC: Cardiovascular Imaging 2017;10:482–85.

  27. Meduri CU, Reardon MJ, Lim DS et al. Novel multiphase assessment for predicting left ventricular outflow tract obstruction before transcatheter mitral valve replacement. JACC: Cardiovascular Interventions 2019;12:2402–12.

  28. Wang DD, Eng MH, Greenbaum AB, et al. Validating a prediction modeling tool for left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR). Catheter Cardiovasc Interv. 2018;92:379–87.

    Article  Google Scholar 

  29. Babaliaros Vasilis C, Lederman Robert J, Gleason Patrick T et al. The art of SAPIEN 3 transcatheter mitral valve replacement in valve-in-ring and valve-in-mitral-annular-calcification procedures. JACC: Cardiovascular Interventions 2021;14:2195–2214.

  30. Harb SC, Kapadia SR. The anterior leaflet length matters. JACC: Cardiovascular Interventions 2021;14:2749–50.

  31. Yoon S-H, Whisenant BK, Bleiziffer S, et al. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J. 2018;40:441–51.

    Article  Google Scholar 

  32. Blanke P, Park JK, Grayburn P, et al. Left ventricular access point determination for a coaxial approach to the mitral annular landing zone in transcatheter mitral valve replacement. J Cardiovasc Comput Tomogr. 2017;11:281–7.

    Article  Google Scholar 

  33. Weir-McCall JR, Blanke P, Naoum C, Delgado V, Bax JJ, Leipsic J. Mitral valve imaging with CT: relationship with transcatheter mitral valve interventions. Radiology. 2018;288:638–55.

    Article  Google Scholar 

  34. •• Ooms Joris F, Wang Dee D, Rajani R, et al. Computed tomography–derived 3D modeling to guide sizing and planning of transcatheter mitral valve interventions. JACC: Cardiovascular Imaging 2021;14:1644–58. This paper explains in details the importance and role of CT-derived 3D prinitng, an emmergent imaging modality, in planning and guiding transcatheter mitral valve interventions.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Reza Reyaldeen, Simrat Kaur, Amar Krishnaswamy, Jay Ramchand, Habib Layoun, Rhonda Miyasaka, Samir R. Kapadia & Serge C. Harb

  2. Department of Diagnostic Radiology, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Paul Schoenhagen

  3. Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Shinya Unai

Authors
  1. Reza Reyaldeen
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  2. Simrat Kaur
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Correspondence to Serge C. Harb.

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Conflict of Interest

Serge Harb reports personal fees from Abbott, Mitria Medical, and Boston Scientific, outside the submitted work. The other authors declare no conflicts of interest.

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Reyaldeen, R., Kaur, S., Krishnaswamy, A. et al. Role of Cardiac Computed Tomography in Planning Transcatheter Mitral Valve Replacement (TMVR). Curr Cardiol Rep 24, 1917–1932 (2022). https://doi.org/10.1007/s11886-022-01794-2

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  • DOI: https://doi.org/10.1007/s11886-022-01794-2

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