Role of Cardiac CT in Pre-Procedure Planning for Transcatheter Mitral Valve Replacement

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 calcifi-cation 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.

Automated summary

The study found that only a minority of patients referred for TMVR planning actually underwent the procedure, with CCT technology being able to identify unsuitable anatomy and leading to exclusion in a significant number of cases.