Tricuspid Valve Regurgitation Decreases after MitraClip Implantation: Fluid Structure Interaction Simulation

Area of Science:

• Cardiovascular Engineering
• Biomedical Simulation
• Medical Device Optimization

Background:

• Untreated tricuspid regurgitation (TR) significantly increases mortality, morbidity, and hospitalization rates.
• Current pharmacological and surgical treatments for TR are limited, necessitating novel interventions.
• The MitraClip (MC) is an emerging percutaneous edge-to-edge intervention for TR treatment.

Purpose of the Study:

• To investigate the impact of MitraClip (MC) device positioning on tricuspid regurgitation (TR) severity.
• To utilize multiphysics fluid-structure interaction (FSI) analysis for quantitative assessment of MC interventions.
• To identify optimal MC placement for maximizing TR reduction and minimizing leaflet stress.

Main Methods:

• Developed a multiphysics fluid-structure interaction (FSI) computational model of the tricuspid valve (TV), chordae tendineae, and blood.
• Simulated normal, diseased (chordal avulsion), and four MC-treated TV conditions.
• Analyzed blood flow dynamics and leaflet stresses for single and dual MC placements at varying positions.

Main Results:

• Diseased TV exhibited a significant increase in TR (7.5%) compared to normal TV (2.5%).
• All simulated MC placements reduced TR; optimal reduction (75.2%) achieved with a single MC midway between annulus and leaflet tip.
• MC placement near leaflet tips resulted in minimal TR reduction (2.2%) and highest leaflet stresses; dual MCs offered no advantage over optimal single MC.

Conclusions:

• Computational FSI analysis confirms the efficacy of MC for TR treatment.
• Optimal MC positioning is crucial for maximizing regurgitation reduction.
• Midway MC placement demonstrates superior efficacy and potentially lower stress compared to leaflet tip placement, guiding future intervention strategies.