Neo-LVOT and Transcatheter Mitral Valve Replacement: Expert Recommendations.

With the advent of transcatheter mitral valve replacement (TMVR), the concept of the neo-left ventricular outflow tract (LVOT) was introduced and remains an essential component of treatment planning. This paper describes the LVOT anatomy and provides a step-by-step computed tomography methodology to segment and measure the neo-LVOT while discussing the current evidence and outstanding challenges. It also discusses the technical and hemodynamic factors that play a major role in assessing the neo-LVOT. A summary of expert-based recommendations about the overall risk of LVOT obstruction in different scenarios is presented along with the currently available methods to reduce the risk of LVOT obstruction and other post-procedural complications.
Competing Interests: Funding Support and Author Disclosures Dr. Wang has served as a consultant for Edwards Lifesciences and Boston Scientific; has received research grant support from Boston Scientific; and had patents on left ventricular outflow tract prediction modeling software assigned to assigned to her employer (Henry Ford Health System). Dr. Piazza is a consultant for Medtronic, HighLife, MicroPort, and Circle CVI. Dr. Cavalcante has received institutional grants to provide core lab services and consultant services to Boston Scientific, Edwards LifeSciences, and Abbott Structural; and received research support from 3Mensio, Circle CVI, Medis, and Siemens Healthineers. Drs. Blanke and Leipsic have received institutional grants to provide core lab services from Edwards Lifesciences, Medtronic, and Abbott; and served as consultants to Circle CVI and MVRX. Dr. Blanke has served as a consultant to Edwards Lifesciences and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)