Emerging Approaches to Management of Left Ventricular Outflow Obstruction Risk in Transcatheter Mitral Valve Replacement

JACC Cardiovasc Interv. 2023 Apr 24;16(8):885-895. doi: 10.1016/j.jcin.2023.01.357.

Abstract

An increasing number of patients with mitral valve disease are high risk for surgery and in need of less invasive treatments including transcatheter mitral valve replacement (TMVR). Left ventricular outflow tract (LVOT) obstruction is a predictor of poor outcome after TMVR, and its risk can be accurately predicted using cardiac computed tomography analysis. Novel treatment strategies that have shown efficacy in reducing risk of LVOT obstruction after TMVR include pre-emptive alcohol septal ablation, radiofrequency ablation, and anterior leaflet electrosurgical laceration. This review describes recent advances in the management of LVOT obstruction risk after TMVR, provides a new management algorithm, and explores forthcoming studies that will further advance the field.

Keywords: ablation; left ventricular outflow tract obstruction; transcatheter mitral replacement.

Publication types

  • Review

MeSH terms

  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / methods
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / methods
  • Heart Valve Prosthesis*
  • Humans
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / surgery
  • Treatment Outcome
  • Ventricular Outflow Obstruction* / diagnostic imaging
  • Ventricular Outflow Obstruction* / etiology
  • Ventricular Outflow Obstruction* / surgery
  • Ventricular Outflow Obstruction, Left*