Key result
MitraClip implantation immediately decreased mitral regurgitation severity and improved hemodynamics, but imposed non-physiologic loading with anterior and posterior leaflet stress increasing up to 210% and 145% during diastole.
Why the study?
MitraClip has recently expanded as a treatment option for heart failure with functional MR, prompting evaluation of the morphologic, hemodynamic, structural, and biomechanical interactions with the left heart complex.
Does simulated MitraClip implantation alter morphologic, hemodynamic, and structural parameters in a patient-specific left heart model of functional mitral regurgitation?
Does simulated MitraClip implantation alter morphologic, hemodynamic, and structural parameters in a patient-specific left heart model of functional mitral regurgitation?
Patient-specific computer simulations of MitraClip implantation demonstrate reduced regurgitant volume but significantly increased leaflet stress and potential for mitral stenosis depending on clip configuration.
Answers are grounded in this paper and cite their sources.
Simulation data on MitraClip hemodynamics should not yet guide practice; leaves open need for clinical validation in heart failure.
Percutaneous edge-to-edge mitral valve (MV) repair using MitraClip has been recently established as a treatment option for patients with heart failure and functional mitral regurgitation (MR), which significantly expands the number of patients that can be treated with this device. This study aimed to quantify the morphologic, hemodynamic and structural changes, and evaluate the biomechanical interaction between the MitraClip and the left heart (LH) complex of a heart failure patient with functional MR using a fluid-structure interaction (FSI) modeling framework. MitraClip implantation using lateral, central and double clip positions, as well as combined annuloplasty procedures were simulated in a patient-specific LH model that integrates detailed anatomic structures, incorporates age- and gender-matched non-linear elastic material properties, and accounts for mitral chordae tethering. Our results showed that antero-posterior distance, mitral annulus spherecity index, anatomic regurgitant orifice area, and anatomic opening orifice area decreased by up to 28, 39, 52, and 71%, respectively, when compared to the pre-clip model. MitraClip implantation immediately decreased the MR severity and improved the hemodynamic profile, but imposed a non-physiologic configuration and loading on the mitral apparatus, with anterior and posterior leaflet stress significantly increasing up to 210 and 145% during diastole, respectively. For this patient case, while implanting a combined central clip and ring resulted in the highest reduction in the regurgitant volume (46%), this configuration also led to mitral stenosis. Patient-specific computer simulations as used here can be a powerful tool to examine the complex device-host biomechanical interaction, and may be useful to guide device positioning for potential favorable clinical outcomes.
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Caballero et al. (2020) studied Functional mitral regurgitation and heart failure (n=1). MitraClip (lateral, central, double clip, and combined annuloplasty) vs. Pre-clip baseline state was evaluated on Morphologic, hemodynamic, and structural changes (including regurgitant volume and leaflet stress). MitraClip implantation immediately decreased mitral regurgitation severity and improved hemodynamics, but imposed non-physiologic loading with anterior and posterior leaflet stress increasing up to 210% and 145% during diastole.
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