Interventions for valvular disease and heart failure

Screening for transcatheter mitral valve replacement: a decision tree algorithm

EuroIntervention 2020;16:251-258. DOI: 10.4244/EIJ-D-19-01051

Sebastian Ludwig
Sebastian Ludwig1, MD; Nicole Ruebsamen1,2, PhD; Florian Deuschl1, MD; Niklas Schofer1, MD; Daniel Kalbacher1, MD; Andreas Schaefer3, MD; Benedikt Koell3, MD; Dirk Westermann1, MD; Hermann Reichenspurner3, MD, PhD; Stefan Blankenberg1, MD; Ulrich Schäfer4, MD; Lenard Conradi3, MD; Edith Lubos1, MD
1. Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; 2. Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany; 3. Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany; 4. Department of Cardiology, Angiology and Intensive Care, Marienkrankenhaus, Hamburg, Germany

Aims: The high frequency of screening failure for anatomical reasons in patients with severe mitral valve regurgitation (MR) is a limiting factor in the screening process for transcatheter mitral valve replacement (TMVR). However, data on optimal patient selection are scarce. The present study aimed to develop a screening algorithm based on TMVR screening data.

Methods and results: A total of 195 screenings for six different TMVR devices were performed in 94 high-risk patients with severe MR. We compared baseline echocardiographic and multislice computed tomography (MSCT) parameters between the subgroups of patients accepted (N=33) and rejected for TMVR (N=61). Reasons for screening failure were assessed, and a decision tree algorithm was statistically derived. Reasons for screening failure were small LV dimensions (30.6%), small (7.5%) or large (22.5%) annular size, potential risk of LVOT obstruction (22.0%) or mitral annulus calcification (15.6%). A four-step decision tree algorithm to assess TMVR eligibility was developed resulting in an AUC of 0.80 (95% CI: 0.71, 0.89, p<0.0001).

Conclusions: This study presents the first screening algorithm to assess anatomical eligibility for TMVR in patients with severe MR, based on simple MSCT criteria. Given the high rate of TMVR screening failure, this algorithm may facilitate the identification of potential TMVR candidates.

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imaging modalitiesmitral regurgitationmitral valve diseasemsct
Interventions for valvular diseaseMitral valve replacement and repair
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