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Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
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CT-Based Annular Dimensions in Transcatheter Mitral Valve Replacement: A Multicenter Registry Study
Liliane Zillner1, Mirjam G Wild2, Michaela M Hell3
1Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, Austria.
The Annals of Thoracic Surgery
|March 22, 2026
Summary
Larger mitral annulus dimensions and increased Annular Area Loss predict one-year cardiac death in transcatheter mitral valve replacement (TMVR) patients. Comprehensive annular assessment aids patient selection for TMVR.
Area of Science:
- Cardiovascular Interventions
- Cardiac Imaging
- Structural Heart Disease
Background:
- Transcatheter mitral valve replacement (TMVR) is a key intervention for severe mitral regurgitation in high-risk patients.
- The prognostic role of mitral annular dimensions in TMVR, particularly with native leaflets, remains underexplored.
Purpose of the Study:
- To investigate the association between preprocedural 4D-CT-derived mitral annular dimensions and mortality outcomes in TMVR patients.
- To evaluate the predictive value of Annular Area Loss for cardiac mortality post-TMVR.
Main Methods:
- Subanalysis of the multicenter TENDER registry including 145 TMVR patients.
- Preprocedural 4D-CT was used to assess annular dimensions.
- Association between annular parameters and cardiac/all-cause mortality at one year was analyzed.
Main Results:
- One-year all-cause mortality was 24.8% and cardiac mortality was 5.5%.
- Larger annular dimensions (anteroposterior diameter, perimeter, area) were significantly associated with cardiac deaths.
- Greater Annular Area Loss was significantly associated with cardiac mortality (OR=1.005, p=0.030).
Conclusions:
- Increased mitral annular dimensions and Annular Area Loss are potential predictors of one-year cardiac death after TMVR.
- Mechanisms may involve impaired left ventricular filling and outflow tract obstruction.
- Detailed annular assessment can improve patient selection for TMVR, especially for transseptal delivery systems.
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