CAD Modeling for Evaluating LVOT Obstruction in Transcatheter Mitral Valve Replacement

The current generation of transcatheter heart valves (THV), as the Edwards SAPIEN 3 Ultra (S3), is not specifically designed for mitral position implantation and has intrinsic design geometry that may make mitral implantation suboptimal. This study aimed to develop a computed-tomography (CT) based CAD workflow for the preoperative planning of transcatheter mitral valve replacement (TMVR) by evaluating the resulting obstruction in the left ventricular outflow tract (LVOT). Specifically, the computational framework to reconstruct heart anatomy and virtually deploy the THV into mitral valve annulus was developed and successively applied to the cases of two patients who experienced annuloplasty ring failure. Planimetric assessment of the cross-sectional area of the neo-LVOT was quantified at different anatomic levels of implanted THV. Findings revealed the importance of the proposed CAD modeling workflow to enable more informative pre-operative assessments of the risk related to the development of the neo-LVOT obstruction and even to guide the Heart Team regarding device selection, sizing and intended positioning for TMVR.