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Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study
BACKGROUND: A clinical study comparing the hemodynamic outcomes of transcatheter mitral valve replacement (TMVR) with vs. without Laceration of the Anterior Mitral leaflet to Prevent Outflow Obstruction (LAMPOON) has never been designed nor conducted. AIMS: To quantify the hemodynamic impact of LAMP...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9261975/ https://www.ncbi.nlm.nih.gov/pubmed/35811698 http://dx.doi.org/10.3389/fcvm.2022.869259 |
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author | Kohli, Keshav Wei, Zhenglun Alan Sadri, Vahid Siefert, Andrew W. Blanke, Philipp Perdoncin, Emily Greenbaum, Adam B. Khan, Jaffar M. Lederman, Robert J. Babaliaros, Vasilis C. Yoganathan, Ajit P. Oshinski, John N. |
author_facet | Kohli, Keshav Wei, Zhenglun Alan Sadri, Vahid Siefert, Andrew W. Blanke, Philipp Perdoncin, Emily Greenbaum, Adam B. Khan, Jaffar M. Lederman, Robert J. Babaliaros, Vasilis C. Yoganathan, Ajit P. Oshinski, John N. |
author_sort | Kohli, Keshav |
collection | PubMed |
description | BACKGROUND: A clinical study comparing the hemodynamic outcomes of transcatheter mitral valve replacement (TMVR) with vs. without Laceration of the Anterior Mitral leaflet to Prevent Outflow Obstruction (LAMPOON) has never been designed nor conducted. AIMS: To quantify the hemodynamic impact of LAMPOON in TMVR using patient-specific computational (in silico) models. MATERIALS: Eight subjects from the LAMPOON investigational device exemption trial were included who had acceptable computed tomography (CT) data for analysis. All subjects were anticipated to be at prohibitive risk of left ventricular outflow tract (LVOT) obstruction from TMVR, and underwent successful LAMPOON immediately followed by TMVR. Using post-procedure CT scans, two 3D anatomical models were created for each subject: (1) TMVR with LAMPOON (performed procedure), and (2) TMVR without LAMPOON (virtual control). A validated computational fluid dynamics (CFD) paradigm was then used to simulate the hemodynamic outcomes for each condition. RESULTS: LAMPOON exposed on average 2 ± 0.6 transcatheter valve cells (70 ± 20 mm(2) total increase in outflow area) which provided an additional pathway for flow into the LVOT. As compared to TMVR without LAMPOON, TMVR with LAMPOON resulted in lower peak LVOT velocity, lower peak LVOT gradient, and higher peak LVOT effective orifice area by 0.4 ± 0.3 m/s (14 ± 7% improvement, p = 0.006), 7.6 ± 10.9 mmHg (31 ± 17% improvement, p = 0.01), and 0.2 ± 0.1 cm(2) (17 ± 9% improvement, p = 0.002), respectively. CONCLUSION: This was the first study to permit a quantitative, patient-specific comparison of LVOT hemodynamics following TMVR with and without LAMPOON. The LAMPOON procedure achieved a critical increment in outflow area which was effective for improving LVOT hemodynamics, particularly for subjects with a small neo-left ventricular outflow tract (neo-LVOT). |
format | Online Article Text |
id | pubmed-9261975 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92619752022-07-08 Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study Kohli, Keshav Wei, Zhenglun Alan Sadri, Vahid Siefert, Andrew W. Blanke, Philipp Perdoncin, Emily Greenbaum, Adam B. Khan, Jaffar M. Lederman, Robert J. Babaliaros, Vasilis C. Yoganathan, Ajit P. Oshinski, John N. Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: A clinical study comparing the hemodynamic outcomes of transcatheter mitral valve replacement (TMVR) with vs. without Laceration of the Anterior Mitral leaflet to Prevent Outflow Obstruction (LAMPOON) has never been designed nor conducted. AIMS: To quantify the hemodynamic impact of LAMPOON in TMVR using patient-specific computational (in silico) models. MATERIALS: Eight subjects from the LAMPOON investigational device exemption trial were included who had acceptable computed tomography (CT) data for analysis. All subjects were anticipated to be at prohibitive risk of left ventricular outflow tract (LVOT) obstruction from TMVR, and underwent successful LAMPOON immediately followed by TMVR. Using post-procedure CT scans, two 3D anatomical models were created for each subject: (1) TMVR with LAMPOON (performed procedure), and (2) TMVR without LAMPOON (virtual control). A validated computational fluid dynamics (CFD) paradigm was then used to simulate the hemodynamic outcomes for each condition. RESULTS: LAMPOON exposed on average 2 ± 0.6 transcatheter valve cells (70 ± 20 mm(2) total increase in outflow area) which provided an additional pathway for flow into the LVOT. As compared to TMVR without LAMPOON, TMVR with LAMPOON resulted in lower peak LVOT velocity, lower peak LVOT gradient, and higher peak LVOT effective orifice area by 0.4 ± 0.3 m/s (14 ± 7% improvement, p = 0.006), 7.6 ± 10.9 mmHg (31 ± 17% improvement, p = 0.01), and 0.2 ± 0.1 cm(2) (17 ± 9% improvement, p = 0.002), respectively. CONCLUSION: This was the first study to permit a quantitative, patient-specific comparison of LVOT hemodynamics following TMVR with and without LAMPOON. The LAMPOON procedure achieved a critical increment in outflow area which was effective for improving LVOT hemodynamics, particularly for subjects with a small neo-left ventricular outflow tract (neo-LVOT). Frontiers Media S.A. 2022-06-09 /pmc/articles/PMC9261975/ /pubmed/35811698 http://dx.doi.org/10.3389/fcvm.2022.869259 Text en Copyright © 2022 Kohli, Wei, Sadri, Siefert, Blanke, Perdoncin, Greenbaum, Khan, Lederman, Babaliaros, Yoganathan and Oshinski. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Kohli, Keshav Wei, Zhenglun Alan Sadri, Vahid Siefert, Andrew W. Blanke, Philipp Perdoncin, Emily Greenbaum, Adam B. Khan, Jaffar M. Lederman, Robert J. Babaliaros, Vasilis C. Yoganathan, Ajit P. Oshinski, John N. Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study |
title | Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study |
title_full | Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study |
title_fullStr | Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study |
title_full_unstemmed | Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study |
title_short | Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study |
title_sort | assessing the hemodynamic impact of anterior leaflet laceration in transcatheter mitral valve replacement: an in silico study |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9261975/ https://www.ncbi.nlm.nih.gov/pubmed/35811698 http://dx.doi.org/10.3389/fcvm.2022.869259 |
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