Bioprosthetic interstrut distance subtending the preserved anterior mitral leaflet mitigates left ventricular outflow tract obstruction

Schematic representation of a normothermic beating-heart ovine model for the research into prevention of left ventricular outflow tract obstruction (LVOTO) using a bioprosthetic mitral valve, with full retention of the anterior mitral leaflet (AML). All episodes of LVOTO were due to systolic anterior motion. The wide interstrut distance subtending the AML was associated with a greater requirement for inotropic stress to precipitate an obstruction and was associated with late systolic rather than holosystolic obstruction.