Effect of Edge-to-Edge Mitral Valve Repair on Chordal Strain: Fluid-Structure Interaction Simulations

• Type of Material: Article
• Authors: Milan Toma, New York Institute Technology; Daniel R. Einstein, St Martins University; Keshav Kohli, Georgia Institute of Technology; Sheridan L. Caroll, Georgia Institute of Technology; Charles H. Bloodworth, Georgia Institute of Technology; Richard P. Cochran, University of Maine; Karyn S. Kunzelman, University of Maine; Ajit Yoganathan, Emory University
• Language: English
• Date: 2020-07-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/biology9070173
• Title of Journal or Parent Work: Biology
• Volume: 9
• Issue: 7
• Start Page: 1
• End Page: 12
• Grant/Funding Information: This research was funded by the National Heart Lung and Blood Institute grant number R01-HL092926.
• Keywords: Regurgitation; Suture; comprehensive model; chordal strain; Life Sciences & Biomedicine; Finite element model; Biology; Stresses; computer simulation; Tendinea; edge-to-edge repair; chordae tendineae; fluid-structure interaction; Life Sciences & Biomedicine - Other Topics; Dilatation, Pathologic; Science & Technology; Replacement; mitral valve
• Research Categories: Health Sciences, Medicine and Surgery; Engineering, Biomedical; Engineering, Mechanical

Abstract

Edge-to-edge repair for mitral valve regurgitation is being increasingly performed in high-surgical risk patients using minimally invasive mitral clipping devices. Known procedural complications include chordal rupture and mitral leaflet perforation. Hence, it is important to quantitatively evaluate the effect of edge-to-edge repair on chordal integrity. in this study, we employ a computational mitral valve model to simulate functional mitral regurgitation (FMR) by creating papillary muscle displacement. Edge-to-edge repair is then modeled by simulated coaptation of the mid portion of the mitral leaflets. in the setting of simulated FMR, edge-to-edge repair was shown to sustain low regurgitant orifice area, until a two fold increase in the inter-papillary muscle distance as compared to the normal mitral valve. Strain in the chordae was evaluated near the papillary muscles and the leaflets. Following edge-to-edge repair, strain near the papillary muscles did not significantly change relative to the unrepaired valve, while strain near the leaflets increased significantly relative to the unrepaired valve. These data demonstrate the potential for computational simulations to aid in the pre-procedural evaluation of possible complications such as chordal rupture and leaflet perforation following percutaneous edge-to-edge repair.