Patient-specific simulation for optimizing transcatheter edge-to-edge repair strategies in mitral regurgitation

Background Transcatheter edge-to-edge repair (TEER) is an effective treatment for mitral regurgitation (MR) but poses challenges due to complex valve anatomy and unpredictable hemodynamics, requiring improved predictive tools. Purpose This study aimed to develop and validate a patient-specific MR simulation platform to optimize TEER strategies. Methods We designed a simulation platform integrating an anatomical model, a pulsatile flow system, and an image assessment system. Primary MR was simulated using clinical imaging data, and TEER strategies were evaluated through preprocedural simulations. The platform was validated in 12 patients by comparing simulated MR parameters (effective regurgitant orifice area [EROA], vena contracta [VC]) with clinical data. It was then applied to guide TEER strategies in 10 patients, simulating 2-3 repair options per case. Results The platform demonstrated strong correlation between simulated and clinical MR parameters (EROA: r2 = 0.9912, p < 0.0001; VC: r2 = 0.9065, p < 0.0001), with no systematic error (Bias = 0.0067 and -0.1783). In 10 patient-specific TEER cases, 90% of final surgical plans were consistent with optimal plans selected through preoperative simulation. Predicted mean mitral valve pressure gradients (MVPG) were slightly higher than postprocedural mean MVPG (3.17 ± 0.76 vs. 2.22 ± 0.44 mmHg, P = 0.028). At 3-month follow-up, all patients had residual MR ≤1+ and mean MVPG ≤2.5 mmHg. Conclusions This patient-specific MR simulation platform enables accurate prediction and optimization of TEER strategies, offering a valuable tool for preprocedural planning and individualized treatment in complex mitral valve anatomies.