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Effect of Edge-to-Edge Mitral Valve Repair on Chordal Strain: Fluid-Structure Interaction Simulations
Milan Toma1,2, Daniel R Einstein3, Keshav Kohli2
1Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury Campus, Northern Boulevard, Old Westbury, NY 11568-8000, USA.
Biology
|July 26, 2020
Summary
Edge-to-edge repair for mitral regurgitation using clipping devices can cause complications. Computational models show increased leaflet strain but stable papillary muscle strain, aiding pre-procedural risk assessment.
Area of Science:
- Cardiovascular engineering
- Biomedical modeling
- Medical device technology
Background:
- Minimally invasive edge-to-edge repair for mitral regurgitation is increasing in high-risk patients.
- Procedural complications include chordal rupture and leaflet perforation.
- Quantitative evaluation of chordal integrity post-repair is crucial.
Purpose of the Study:
- To computationally evaluate the effect of edge-to-edge repair on mitral valve chordal integrity.
- To simulate functional mitral regurgitation (FMR) and assess repair outcomes.
- To identify potential risks of chordal rupture and leaflet perforation.
Main Methods:
- Developed a computational mitral valve model to simulate FMR via papillary muscle displacement.
- Modeled edge-to-edge repair by simulating mid-leaflet coaptation.
- Analyzed chordal strain near papillary muscles and leaflets under simulated FMR and repair.
Main Results:
- Edge-to-edge repair maintained low regurgitant orifice area until a twofold increase in inter-papillary muscle distance.
- Chordal strain near papillary muscles did not significantly change post-repair compared to unrepaired valves.
- Chordal strain near leaflets significantly increased post-repair compared to unrepaired valves.
Conclusions:
- Computational simulations can predict complications like chordal rupture and leaflet perforation.
- Edge-to-edge repair alters stress distribution within the mitral valve apparatus.
- This modeling approach aids in pre-procedural risk assessment for mitral valve interventions.
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